Treatment of Fourth Ventricle Arachnoid Cyst via Anterior Hone of Lateral Ventricle Using Flexible Endoscope

Object Endoscopic surgery is generally withheld in patients with small ventricles due to difficulties in ventricular cannulation and intraventricular manipulation. The effectiveness of flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles was evaluated. Methods Forty-five patients who underwent endoscopic surgery with a flexible endoscope for intraventricular brain tumors were divided into small-ventricle and ventriculomegaly groups according to the frontal and occipital horn ratio (FOR). Retrospective review of these cases was performed and achievement of surgical goals and morbidity were assessed. Results Among the 45 patients, there were 14 with small ventricles and 31 with ventriculomegaly. In the smallventricle group, targeted tumors were located in the suprasellar region in 12 patients and in the pineal region in 2. In the ventriculomegaly group, tumors were located in the pineal region in 15 patients, in the suprasellar region in 9, in the lateral ventricle in 4, in the midbrain in 2, and in the fourth ventricle in 1. In the small-ventricle group, ventricular cannulation was successful and the surgical goals were accomplished in all patients. In ventriculomegaly group, sampling of the tumor was not diagnostic due to intraoperative hemorrhage in 1 patient. There were no significant differences in the rate of achieving the surgical goals or the morbidity between the 2 groups. Conclusions Endoscopic surgery using a flexible endoscope is useful for management of intraventricular brain tumors in patients with small ventricles. A flexible endoscope allows excellent maneuverability in introducing the device into the lateral ventricle and manipulating through small ventricles.

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Giant syringobulbia associated with cerebellopontine angle arachnoid cyst and hydrocephalus

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.4.peds10565 ◽

2011 ◽

Vol 8 (1) ◽

pp. 30-34 ◽

Cited By ~ 2

Author(s):

Ai Muroi ◽

Nigel Peter Syms ◽

Shizuo Oi

Keyword(s):

Arachnoid Cyst ◽

Head Circumference ◽

Lateral Ventricle ◽

Cerebellopontine Angle ◽

External Ventricular Drainage ◽

Magnetic Resonance Images ◽

Ventricular Catheter ◽

Cerebrospinal Fluid Diversion ◽

Left Lateral Ventricle ◽

The Brain

The aim in reporting this case was to discuss the pathophysiology and treatment issues in an infant with a giant syringobulbia associated with a right cerebellopontine angle (CPA) arachnoid cyst causing noncommunicating hydrocephalus. This 7-month-old infant presented to the hospital with a history of delayed milestones and an abnormal increase in head circumference. Magnetic resonance images and CT scans of the brain showed a large CSF cavity involving the entire brainstem and a right CPA arachnoid cyst causing obstruction of the fourth ventricle and dilation of the lateral and third ventricles. Cerebrospinal fluid diversion was performed by direct communication from the syringobulbia cavity to the left lateral ventricle and from the left lateral ventricle through another ventricular catheter; external ventricular drainage was performed temporarily for 5 days. Communication between the syrinx and arachnoid cyst was confirmed. Clinically, there was a reduction in head circumference, and serial MR imaging of the brain showed a decrease in the size of the syrinx cavity and the ventricle along with opening of the normal CSF pathways. The postoperative course was uneventful, and no further intervention was necessary. On follow-up of the child at 3 years, his developmental milestones were normal. Surgical intervention for this condition is mandatory. The appropriate type of surgery should be performed on the basis of the pathophysiology of the developing syringobulbia.

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Lateral Ventricle to Sylvian Fissure Shunt for Obstructive Hydrocephalus: First Report

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1600516 ◽

2017 ◽

Vol 78 (05) ◽

pp. 513-516

Author(s):

Sushil Patkar

Keyword(s):

Lateral Ventricle ◽

Fourth Ventricle ◽

Superior Sagittal Sinus ◽

Obstructive Hydrocephalus ◽

Shunt Operation ◽

Ventriculoatrial Shunt ◽

Sagittal Sinus ◽

Suprasellar Cistern ◽

Sylvian Cistern

AbstractCerebrospinal fluid (CSF) pathway studies have revealed that the CSF secreted from the choroid plexus of the ventricles after egressing from the fourth ventricle reaches the basal suprasellar cistern and ultimately the sylvian cisterns. From the sylvian cistern, the CSF travels over the cerebral convexity subarachnoid space to reach the superior sagittal sinus and enters the bloodstream. Diverting CSF from the lateral ventricle with a shunt catheter to the sylvian cistern can be an option to treat obstructive hydrocephalus. An adult patient with posttraumatic hydrocephalus with contraindications to ventriculoperitoneal and ventriculoatrial shunt placement underwent this procedure of diverting CSF from the lateral ventricle to the sylvian cistern successfully, and he had immediate relief of symptoms of raised intracranial pressure. Although preliminary results seem logical and promising, more cases and longer follow-up is required to consider this shunt operation an option in the treatment of obstructive hydrocephalus.

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Intraventricular arachnoid cyst of lateral ventricle in an elderly patient

Romanian Neurosurgery ◽

10.33962/roneuro-2020-014 ◽

2020 ◽

pp. 106-109

Author(s):

Rajneesh Misra ◽

Sushil Kumar ◽

Sandeep Sharma ◽

Pankaj Bharadva

Keyword(s):

Elderly Patient ◽

Arachnoid Cyst ◽

Lateral Ventricle ◽

Cystic Lesion ◽

Arachnoid Cysts

Arachnoid cysts are usually located in relation to the arachnoid cisterns. Intra-ventricular location is rare and its embryological emergence in this site is controversial. We report a large intra-ventricular cyst in a 61-year-old female who presented with decreased vision, headache and right hemiparesis. MRI was suggestive of cystic lesion in the lateral ventricle and was excised completely through a craniotomy.

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Microsurgical treatment of a large posterior fossa arachnoid cyst

Archives of Pediatric Neurosurgery ◽

10.46900/apn.v2i3(september-december).59 ◽

2020 ◽

Vol 2 (3(September-December)) ◽

pp. e592020

Author(s):

Leopoldo Mandic Ferreira Furtado ◽

José Aloysio da Costa Val Filho ◽

François Dantas ◽

Camila Moura De Sousa

Keyword(s):

Posterior Fossa ◽

Arachnoid Cyst ◽

Motor Development ◽

Fourth Ventricle ◽

Open Surgery ◽

Surgical Strategies ◽

Development Delay ◽

Microsurgical Resection ◽

Cystoperitoneal Shunting ◽

Endoscopic Fenestration

Introduction: Arachnoid cysts are fluid-filled malformations of the arachnoid tissue. A prevalence in children of 2,6% has been reported[2,3]. Surgical strategies of treatment include open surgery with cyst wall excision , endoscopic fenestration or cystoperitoneal shunting[1,4]. Methods: In this video case, we described the case of a 1 year and 7 months old child who presented with motor development delay, unable to walk, who underwent microsurgical resection of a large posterior fossa arachnoid cyst and communication with the fourth ventricle. Conclusion: Microsurgery approach provides a safe anatomic control over the cyst and the recognition of floor of the fourth ventricle.

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Arachnoid Cyst of the Fourth Ventricle

Neurologia medico-chirurgica ◽

10.2176/nmc.30.848 ◽

1990 ◽

Vol 30 (11) ◽

pp. 848-852 ◽

Cited By ~ 6

Author(s):

Tsuneo MAKIUCHI ◽

Koki KADOTA ◽

Tetsuhiko ASAKURA ◽

Kohichi UCHIMURA ◽

Kohji TODOROKI ◽

...

Keyword(s):

Arachnoid Cyst ◽

Fourth Ventricle

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Disproportionately Large Communicating Fourth Ventricle Associated With Syringomyelia and Intradural Arachnoid Cyst in the Spinal Cord Successfully Treated With Additional Shunting

Neurologia medico-chirurgica ◽

10.2176/nmc.52.231 ◽

2012 ◽

Vol 52 (4) ◽

pp. 231-234 ◽

Cited By ~ 3

Author(s):

Tae YAMASHITA ◽

Hisaya HIRAMATSU ◽

Yoshihiro KITAHAMA ◽

Tsutomu TOKUYAMA ◽

Kenji SUGIYAMA ◽

...

Keyword(s):

Spinal Cord ◽

Arachnoid Cyst ◽

Fourth Ventricle

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Arachnoid Cyst of the Fourth Ventricle Manifesting Normal Pressure Hydrocephalus

Neurosurgery ◽

10.1227/00006123-198301000-00018 ◽

1983 ◽

Vol 12 (1) ◽

pp. 108-110 ◽

Cited By ~ 26

Author(s):

Kazuyoshi Korosue ◽

Norihiko Tamaki ◽

Kiyoshi Fujiwara ◽

Satoshi Matsumoto

Keyword(s):

Arachnoid Cyst ◽

Normal Pressure Hydrocephalus ◽

Fourth Ventricle ◽

Normal Pressure ◽

Complete Recovery ◽

Ventriculoperitoneal Shunting ◽

4Th Ventricle

Abstract The authors report a patient with the syndrome of normal pressure hydrocephalus who had an arachnoid cyst in the 4th ventricle. Ventriculoperitoneal shunting followed by removal of the cyst resulted in a complete recovery.

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Migrating Lateral Ventricle Choroid Plexus Cyst into the Fourth Ventricle Causing Acute Hydrocephalus

Journal of Pediatric Neurology ◽

10.1055/s-0041-1723760 ◽

2021 ◽

Author(s):

Lacey M. Carter ◽

Benjamin Cornwell ◽

Naina L. Gross

Keyword(s):

Cerebrospinal Fluid ◽

Choroid Plexus ◽

Lateral Ventricle ◽

Fourth Ventricle ◽

Third Ventricle ◽

Neurological Deficits ◽

Cerebral Aqueduct ◽

Outflow Obstruction ◽

The Third ◽

Choroid Plexus Cyst

AbstractChoroid plexus cysts consist of abnormal folds of the choroid plexus that typically resolve prior to birth. Rarely, these cysts persist and may cause outflow obstruction of cerebrospinal fluid. We present a 5-month-old male born term who presented with lethargy, vomiting, and a bulging anterior fontanelle. Magnetic resonance imaging showed one large choroid plexus cyst had migrated from the right lateral ventricle through the third ventricle and cerebral aqueduct into the fourth ventricle causing outflow obstruction. The cyst was attached to the lateral ventricle choroid plexus by a pedicle. The cyst was endoscopically retrieved from the fourth ventricle intact and then fenestrated and coagulated along with several other smaller cysts. Histologic examination confirmed the mass was a choroid plexus cyst. The patient did well after surgery and did not require any cerebrospinal fluid diversion. Nine months after surgery, the patient continued to thrive with no neurological deficits. This case is the first we have found in the literature of a lateral ventricular choroid plexus cyst migrating into the fourth ventricle and the youngest of any migrating choroid plexus cyst. Only three other cases of a migrating choroid plexus cyst have been documented and those only migrated into the third ventricle. New imaging advances are making these cysts easier to identify, but may still be missed on routine sequences. High clinical suspicion for these cysts is necessary for correct treatment of this possible cause of hydrocephalus.

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