Transient obstructive hydrocephalus by intraventricular fat migration after surgery of the posterior fossa

Abstract A case of hemangioma calcificans in the 4th ventricle is reported. Skull x-ray films demonstrated a dense calcification in the posterior fossa. Computed tomography disclosed a hyperdense mass in the 4th ventricle. The clinical picture was of increased intracranial pressure due to obstructive hydrocephalus. An hemangioma calcificans in the 4th ventricle was removed successfully.

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Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1728766 ◽

2021 ◽

Author(s):

Prashant Raj Singh ◽

Raghvendra Kumar Sharma ◽

Jitender Chaturvedi ◽

Nitish Nayak ◽

Anil Kumar Sharma

Keyword(s):

Posterior Fossa ◽

Surgical Outcome ◽

Karnofsky Performance Status ◽

Obstructive Hydrocephalus ◽

Case Series ◽

Preoperative Embolization ◽

Initial Symptom ◽

Lower Cranial Nerve ◽

The Mean

Abstract Background Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. Material and Method We share the surgical difficulties and outcome in this case series of large solid hemangioblastomas without preoperative embolization as an adjunct. This study included five patients (three men and two women, with a mean age of 42.2 years). Preoperative embolization was attempted in one patient but was unsuccessful. All the patients have headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt was inserted in one case before definite surgery due to obstructive hydrocephalus. The surgical outcome was measured using the Karnofsky Performance Status (KPS) score. Result The tumor was excised completely in all the cases. No intra- and postoperative morbidity occurred in four patients; one patient developed transient lower cranial nerve palsy. Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up was 80.One patient had a KPS score of 60. Conclusion Our treatment strategy is of circumferential dissection followed by en bloc excision, which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts as color duplex sonography and indocyanine green video angiography may help complete tumor excision with a lesser risk of complication. Preoperative embolization may not be needed to resect large solid posterior fossa hemangioblastoma, including those at the cerebellopontine angle location.

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Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

QJM ◽

10.1093/qjmed/hcab108.011 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Tarek ◽

Hamdy Ibrahim ◽

H Jalalod'din ◽

SR Tawadros

Keyword(s):

Posterior Fossa ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Clinical Findings ◽

Third Ventriculostomy ◽

Posterior Fossa Tumors ◽

Shunt Insertion ◽

Vp Shunt ◽

Csf Diversion

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

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Possibility of Endoscopic Third Ventriculostomy Instead of Internal Drainage System to Treat Obstructive Hydrocephalus in Children with Posterior Fossa Tumours

Journal of Pediatric Oncology ◽

10.14205/2309-3021.2013.01.01.8 ◽

2013 ◽

Author(s):

Ventruba

Keyword(s):

Posterior Fossa ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Drainage System ◽

Third Ventriculostomy ◽

Internal Drainage ◽

Posterior Fossa Tumours

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Endoscopic Third Ventriculostomy before Posterior Fossa Tumor Surgery in Adult Patients

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1608786 ◽

2017 ◽

Vol 79 (02) ◽

pp. 123-129 ◽

Cited By ~ 4

Author(s):

Ahmed El Damaty ◽

Jotham Manwaring ◽

Ehab El Refaee ◽

Steffen Fleck ◽

Michael Fritsch ◽

...

Keyword(s):

Posterior Fossa ◽

Obstructive Hydrocephalus ◽

External Ventricular Drain ◽

Clinical Signs ◽

Adult Patients ◽

Posterior Fossa Tumor ◽

Third Ventriculostomy ◽

Tumor Surgery ◽

Posterior Fossa Tumors ◽

Asymptomatic Patients

Objective Obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen. Treatment options include immediate tumor removal or prior cerebrospinal fluid (CSF) diversion procedures. The necessity and feasibility of an ETV in these situations has not yet been proven in adult patients. Methods We retrospectively reviewed our prospectively maintained database for ETVs before surgery of posterior fossa tumors in adults. The primary focus of data analyses was the question of whether the ETV was suitable to treat the acute situation of hydrocephalus without an increased rate of complications due to the special anatomical situation with a posterior fossa tumor. We also analyzed whether any further CSF diverting procedures were necessary. Results A total of 40 adult patients who underwent an ETV before posterior fossa tumor surgery were analyzed. Overall, 33 patients (82.5%) had clinical signs of hydrocephalus, and all of them improved in their clinical course after ETV. Seven patients (17.5%) did not demonstrate clinical signs of hydrocephalus, but ETV was performed with prophylactic or palliative intent in six patients and one patient, respectively. No complications were observed due to ETV itself. No permanent shunting procedure was necessary in a mean follow-up of 76.5 months. Early additional CSF diverting procedures (redo ETV, external ventricular drain) were performed in five patients (12.5%). Conclusion The present series confirms the feasibility and safety of ETV before posterior fossa tumor surgery in adult patients. If patients had symptomatic hydrocephalus before tumor surgery, an ETV can be performed, followed by early elective tumor surgery. A prophylactic ETV in asymptomatic patients is not advised. Early elective tumor surgery should be performed in these patients.

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Outcome of Endoscopic third Ventriculostomy for Obstructive Hydrocephalus due to Posterior Fossa Lesions

Eastern Green Neurosurgery ◽

10.3126/egn.v2i1.27453 ◽

2020 ◽

Vol 2 (1) ◽

pp. 3-6

Author(s):

Suresh Sapkota ◽

Shikher Shrestha ◽

Suresh Bishokarma ◽

Suraj Thulung ◽

Bibhusan Kalu ◽

...

Keyword(s):

Posterior Fossa ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Symptomatic Improvement ◽

Third Ventriculostomy ◽

Shunt Insertion ◽

Old Patients ◽

Female Ratio ◽

Visual Symptoms ◽

Csf Leakage

Background and purpose: Obstructive hydrocephalus can be treated with External ventricular Drainage (ETV), Ventriculo peritoneal shunt insertion, upfront tumor removal without cerebrospinal fluid diversion procedures or more recently ETV. Aim of our study was to study the outcome of ETV in treating such patients. Material and method: Descriptive observational study conducted at Upendra Devkota Memorial Institute Of Neurological and Allied Sciences from Sep 2015 to may 2017. Result: Twenty-three patients met the inclusion criteria. Among which, 14 (39%) patients were male with male to female ratio of 1.55. We included wide age range from 3 years to 68 years. Seven patients (30.4%) were less than 10 years while 6 patients (23%) were above 60 years old. Patients with Posterior fossa presented with varied symptoms. Ten patients (43.4%) presented with decreased level of consciousness, 14 (60.8%) presented with visual symptoms, 17 (73.9%) presented with vomiting and 23 (100%) presented with headache (Figure. 3). Visual acuity was normal among 3 (13%), decreased among 11 (48%) and with no perception of light among 3 (13%). However, acuity was not assessed among 6 (26%) patients (Figure 4).Funduscopic evaluation revealed papilledema among 20 (87%) patients while secondary optic atrophy among 3 (13%) patients. Patients were evaluated in follow up for symptomatic improvement. Consciousness were improved among 8 (80%) patients, visual symptoms improved among 10 (71.4%) patients, vomiting subsided among 15 (88.2%) patients while headache improved among 100%. Following ETV, 5 (21.7%) patients developed complications, 3 (13%) patients had intraventricular bleeding while 2 (8.6%) patients had CSF leakage from the wound. Conclusion: Endoscopic third ventriculostomy is a relatively safe and valid option for treatment obstructive hydrocephalus due to posterior fossa lesions.

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Posterior Fossa Ependymoma

Pediatric Neurosurgery ◽

10.1093/med/9780190617073.003.0025 ◽

2019 ◽

pp. 223-230

Author(s):

Frederick A. Boop ◽

Jimmy Ming-Jung Chuang

Keyword(s):

Posterior Fossa ◽

Fourth Ventricle ◽

Obstructive Hydrocephalus ◽

Standard Of Care ◽

Extent Of Resection ◽

Clinical Findings ◽

Current Standard ◽

Subarachnoid Spaces ◽

Growth Of Tumor ◽

Foramen Of Luschka

Pediatric posterior fossa ependymomas are typically well-delineated masses with heterogenous enhancement arising from the floor, lateral aspect, or roof of the fourth ventricle. Growth of tumor into the posterior fossa subarachnoid spaces, particularly into the foramen of Magendie and the cerebellopontine angles via the foramen of Luschka, is a radiological hallmark of this tumor. Clinical findings of elevated intracranial pressure and obstructive hydrocephalus are common at presentation. The current standard of care for children with ependymoma consists of gross total resection with subsequent focal radiotherapy. The extent of resection is the single most important determinant of outcome. Hydrocephalus typically resolves after resection, and it is uncommon to require cerebrospinal shunt placement after tumor removal.

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Utility of True Fast Imaging with Steady-State Precession in Detecting Arachnoid Veils of the Posterior Fossa

Pediatric Neurosurgery ◽

10.1159/000515033 ◽

2021 ◽

pp. 1-8

Author(s):

Alon Kashanian ◽

Nader Binesh ◽

Barry D. Pressman ◽

Moise Danielpour

Keyword(s):

Steady State ◽

Posterior Fossa ◽

Imaging Techniques ◽

Obstructive Hydrocephalus ◽

Symptomatic Improvement ◽

Fast Imaging ◽

Csf Flow ◽

Spatiotemporal Resolution ◽

Obstructive Lesion ◽

Steady State Precession

Introduction: Arachnoid membranes are well recognized as a cause of cerebrospinal fluid (CSF) flow impairment in disorders such as obstructive hydrocephalus and syringohydromyelia, but can be difficult to detect with standard noninvasive imaging techniques. True fast imaging with steady-state precession (TrueFISP) can exhibit brain pulsations and CSF dynamics with high spatiotemporal resolution. Here, we demonstrate the utility of this technique in the diagnosis and management of arachnoid membranes in the posterior fossa. Case Presentations: Three symptomatic children underwent cine TrueFISP imaging for suspicion of CSF membranous obstruction. Whereas standard imaging failed to or did not clearly visualize the site of an obstructive lesion, preoperative TrueFISP identified a membrane in all 3 cases. The membranes were confirmed intraoperatively, and postoperative TrueFISP helped verify adequate marsupialization and recommunication of CSF flow. Two out of the 3 cases showed a decrease in cerebellar tonsillar pulsatility following surgery. All children showed symptomatic improvement. Conclusion: TrueFISP is able to detect pulsatile arachnoid membranes responsible for CSF outflow obstruction that are otherwise difficult to visualize using standard imaging techniques. We advocate use of this technology in pre- and postsurgical decision-making as it provides a more representative image of posterior fossa pathology and contributes to our understanding of CSF flow dynamics. There is potential to use this technology to establish prognostic biomarkers for disorders of CSF hydrodynamics.

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SURG-28. PRESENTATION OF A POSTERIOR FOSSA TUMOR AT A HOSPITAL IN WESTERN JAMAICA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.874 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii209-ii209

Author(s):

Brandon Dixon ◽

Renn Holness ◽

Tasha-Kay Walker ◽

Franz Pencle

Keyword(s):

Posterior Fossa ◽

Pediatric Population ◽

Obstructive Hydrocephalus ◽

Foramen Magnum ◽

Csf Leak ◽

Low Grade ◽

Who Grade ◽

Lumbar Drain ◽

Primary Neoplasms ◽

Ct Brain

Abstract The posterior cranial fossa is part of the cranial cavity, located between the foramen magnum and tentorium cerebelli that houses the cerebellum, pons and medulla oblongata. Commonly, tumors arising from this region in adults are cerebellar metastases or schwannomas of the vestibular nerve – the incidence of primary neoplasms is uncommon and more reserved for the pediatric population. A 28 year old female was in her usual state of health until last year when she started experiencing recurrent headaches with associated vomiting and intermittent loss of consciousness. A CT brain was done upon presentation to the hospital that revealed a 4th ventricle mass with obstructive hydrocephalus. A ventriculoperitoneal (VP) shunt was done thereafter to decompress the ventricular system, in anticipation for further surgical intervention for mass. Occipital craniotomy and resection of tumor was done and patient managed in a multidisciplinary manner in the intensive care unit. Post-operative course was marked by occipital pseudomeningocele with an associated CSF leak; a lumbar drain was placed in situ until complete resolution of leak. Histological analysis showed WHO Grade II Astrocytoma. Adult primary posterior fossa tumors are rare and can present with a constellation of symptoms. Although patient presented with findings in keeping with the diagnosis of an ependymoma, close clinical follow up will be required henceforth due to the refractory nature of such a low grade astrocytoma post-resection. Radiotherapy can also be considered in further management of case.

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