Vertebrobasilar Dolichoectasia, Hypoplastic Third Ventricle, and Related Biventricular Hydrocephalus: Case Report and Review of the Literature

Abstract Background Vertebrobasilar dolichoectasia (VBDE) is defined as a symptomatic dilatation and tortuosity of the vertebrobasilar arteries. The risk of hydrocephalus development is due to direct compression of the third ventricle outflow or brainstem compression and related aqueduct stenosis. We present an uncommon case of a patient with symptomatic VBDE with the uniqueness of a hypoplastic third ventricle associated with biventricular hydrocephalus. A literature review concerning diagnosis and management of patients affected by biventricular hydrocephalus caused by VBDE was also performed. Case Illustration We report a case of a 54-year-old man who presented with headache, ideomotor apraxia, and gait disorder. A head computed tomography (CT) scan showed a biventricular hydrocephalus and a subsequent CT angiography documented the presence of a VBDE compressing the anterior part of the third ventricle that also appeared hypoplastic. The patient also presented a clinical history of arterial hypertension for which he was given a proper pharmacologic treatment with symptom relief. A surgical treatment of ventriculoperitoneal shunt along with endoscopic septostomy was proposed, but the patient refused, probably due to the slightly positive response to medical treatment. Conclusions The natural clinical history of patients affected by VBDE is unfavorable with 7.8 years of median survival. The therapeutic strategy is usually conservative and the role of antiplatelets or oral anticoagulants is still debated. In selected patients, ventriculoperitoneal shunt to resolve intracranial hypertension caused by biventricular hydrocephalus is the most effective treatment. In our opinion, chronic third ventricle compression could lead to anatomic–pathologic alterations like the third ventricle hypoplasia documented in our report.

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Vasopressin in blood and third ventricle CSF of dogs in chronic experiments

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1983.245.4.r541 ◽

1983 ◽

Vol 245 (4) ◽

pp. R541-R548 ◽

Cited By ~ 1

Author(s):

C. Simon-Oppermann ◽

D. Gray ◽

E. Szczepanska-Sadowska ◽

E. Simon

Keyword(s):

Cerebrospinal Fluid ◽

Arginine Vasopressin ◽

Anterior Part ◽

Third Ventricle ◽

Conscious State ◽

Conscious Dogs ◽

Inhalation Anesthesia ◽

Blood Samples ◽

The Third ◽

Device Implantation

A device for chronic implantation was developed that allowed sampling of cerebrospinal fluid (CSF) from the anterior part of the third cerebral ventricle (A3V) of dogs in repeated experiments for up to 4 mo. Osmolalities, electrolyte concentrations, and concentrations of arginine vasopressin (AVP) measured with a radioimmunoassay were determined in repeated experiments on the chronically prepared animals under conditions of normal hydration, both in the conscious state and during inhalation anesthesia. In conscious dogs, AVP concentrations in plasma and CSF were 3.3 +/- 0.4 and 21.8 +/- 2.5 pg X ml-1, respectively. During anesthesia without surgical interference, the AVP concentrations in plasma and CSF were increased twofold above the levels obtained in conscious dogs. During the time of observation (180 min) all measured parameters remained constant. The AVP concentrations in plasma and CSF samples collected during the surgical procedure of device implantation were about 10-fold higher than in the samples collected during the conscious state. Thus, in each experimental condition, AVP concentration in the CSF collected from the A3V was consistently higher than that in the simultaneously collected blood samples.

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Hematoma from arteriovenous malformation producing hydrocephalus and simulating a thalamic tumor

Journal of Neurosurgery ◽

10.3171/jns.1971.34.2part1.0229 ◽

1971 ◽

Vol 34 (2) ◽

pp. 229-235 ◽

Cited By ~ 6

Author(s):

Larry K. T. Ng ◽

Gabriel Schwarz ◽

Mark M. Mishkin

Keyword(s):

Vascular Malformation ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Intracerebral Hematoma ◽

Content Type ◽

The Third ◽

Brain Substance ◽

History Of ◽

The Brain ◽

Symptoms And Signs

✓ Two patients with a history of progressive unilateral neurological symptoms and signs, and evidence of obstructive hydrocephalus from a mass lesion adjacent to the third ventricle as demonstrated by pneumography, were each found to have an intracerebral hematoma secondary to remote hemorrhage from a small vascular malformation. One patient died shortly after surgical exploration and the other after ventriculography. The pathophysiology of hydrocephalus associated with a vascular malformation is discussed and the need for considering a benign cause for obstructive hydrocephalus from a mass deep in the brain substance is emphasized.

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Surgical management of craniopharyngioma with third ventricle involvement

Neurosurgical FOCUS ◽

10.3171/2013.v1.focus12330 ◽

2013 ◽

Vol 34 (v1supplement) ◽

pp. 1 ◽

Cited By ~ 3

Author(s):

Danielle de Lara ◽

Leo F. S. Ditzel Filho ◽

Jun Muto ◽

Bradley A. Otto ◽

Ricardo L. Carrau ◽

...

Keyword(s):

Third Ventricle ◽

Postoperative Recovery ◽

Direct Access ◽

Cerebrospinal Fluid Leakage ◽

Nasoseptal Flap ◽

Total Removal ◽

Tumor Removal ◽

The Third ◽

Suprasellar Region ◽

History Of

Craniopharyngiomas are notorious for their ability to invade the hypothalamus and third ventricle. Although several transcranial approaches have been proposed for their treatment, the endonasal route provides direct access to the tumor with no need for cerebral retraction or manipulation of the optic apparatus. After the lesion is debulked, the unique angle of approach achieved with this technique enables the surgeon to perform an extra-capsular dissection and visualize the walls of the third ventricle, the foramina of Monro, and the anterior comissure. Moreover, the enhanced magnification and lighting afforded by the endoscope facilitate safe tumor removal, particularly in areas where there is loss of clear lesion delimitation and greater infiltration of the surrounding structures.Herein we present the case of a 68-year-old female patient with a 3-month history of visual deterioration accompanied by worsening headaches. Investigation with magnetic resonance imaging revealed a heterogeneous mass in the suprasellar region, extending into the third ventricle and displacing the pituitary gland and stalk inferiorly. Hormonal profile was within expected range for her age. An endonasal, fully endoscopic, transplanum transtuberculum approach was performed. Gross-total removal was achieved and pathology confirmed the diagnosis of craniopharyngioma. Postoperative recovery was marked by transient diabetes insipidus. Closure was achieved with a pedicled nasoseptal flap; despite exploration of the third ventricle, there was no cerebrospinal fluid leakage. Pituitary function was preserved. Visual function has fully recovered and the patient has been uneventfully followed since surgery.The video can be found here: http://youtu.be/it5mpofZl0Q.

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Colloid cyst of velum interpositum: a rare finding

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.11.peds11262 ◽

2012 ◽

Vol 9 (2) ◽

pp. 206-208 ◽

Cited By ~ 4

Author(s):

Tom C. Morris ◽

Stephen Santoreneos

Keyword(s):

Head Injury ◽

Third Ventricle ◽

Memory Deficits ◽

Colloid Cyst ◽

Minor Head Injury ◽

Rare Finding ◽

The Third ◽

History Of ◽

A Minor ◽

Velum Interpositum

The authors present the case of a child with a colloid cyst of the velum interpositum. To the best of the authors' knowledge, this is the first reported case in the pediatric literature and only the second reported case to date. The patient was of an 11-year-old boy in whom this lesion was found after a minor head injury. He had a 6-month history of memory deficits. A lesion consistent with a colloid cyst was seen in the region of the velum interpositum, in the roof of the third ventricle. This lesion was excised successfully via a transcallosal interfornical approach. There were no new postoperative deficits and the child made a full recovery of time.

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Narcolepsy Secondary to Fourth Ventricular Subependymoma

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100039202 ◽

1996 ◽

Vol 23 (1) ◽

pp. 59-62 ◽

Cited By ~ 16

Author(s):

T.K.F. Ma ◽

L.C. Ang ◽

M. Mamelak ◽

S.J. Kish ◽

B. Young ◽

...

Keyword(s):

Fourth Ventricle ◽

Third Ventricle ◽

Cerebral Metastasis ◽

Histologic Examination ◽

Colonic Carcinoma ◽

Anatomical Location ◽

Pathological Changes ◽

The Third ◽

Anatomical Localization ◽

History Of

ABSTRACT:Background:Secondary (symptomatic) narcolepsy is rare. We report a subependymoma of the fourth ventricle associated with narcolepsy. The patient was a 50-year-old woman with a long history of narcolepsy who died of colonic carcinoma with no cerebral metastasis. She was positive for HLA-DR2. At autopsy there was a tumour dorsal to the fourth ventricle which involved the midbrain tectum and rostral pons. Histologic examination of the tumour confirmed it to be a subependymoma.Methods:Review of the previous cases of secondary narcolepsy was made with particular reference to the anatomical location of the lesions.Results:Most of the lesions were found around the third ventricle and rostral brainstem.Conclusions:Knowing the anatomical localization of the pathological changes in secondary narcolepsy could be important in improving our understanding of its pathogenesis.

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Cholesteatoma and hydrocephalus associated to a third ventricle meningioma in a cat

Ciência Rural ◽

10.1590/0103-8478cr20190213 ◽

2019 ◽

Vol 49 (10) ◽

Author(s):

Maria Fernanda Wentz ◽

Thainã Piccolo Vargas ◽

Matheus Viezzer Bianchi ◽

Rochana Rodrigues Fett ◽

Cíntia De Lorenzo ◽

...

Keyword(s):

Neurological Disorders ◽

Third Ventricle ◽

Granulomatous Inflammation ◽

Behavioral Changes ◽

Communicating Hydrocephalus ◽

The Third ◽

Spindle Cells ◽

History Of ◽

The Central Nervous System ◽

Cleft Formation

ABSTRACT: Meningiomas are neoplasms that commonly involve the central nervous system of cats, while cholesteatomas are nodular granulomatous chronic lesions within the choroid plexus that are rarely reported in cats. This study described a case of cholesteatoma and non-communicating hydrocephalus associated to a third ventricle meningioma in a cat. Clinically, the cat had a 2-year history of behavioral changes, photophobia and motor incoordination. At the necropsy, a tan-brown mass totally occluded the third ventricle, causing a severe dilation of the lateral ventricles (non-communicating hydrocephalus). Microscopically, the mass was composed by a neoplastic proliferation of spindle cells arranged in bundles, containing in the center psammomatous bodies (meningioma), while in the adjacent areas a cholesteatoma was observed, which was characterized by multiple cholesterol cleft formation, hemosiderosis and associated granulomatous inflammation. At immunohistochemistry (IHC), neoplastic cells had a marked immunostaining for vimentin, while were negative for cytokeratin and S100. The diagnosis of transitional meningioma occurring in association to cholesteatoma and non-communicating hydrocephalus in a cat was obtained mainly by the histological and IHC features. These are important methods to distinguish this condition from other neurological disorders in cats.

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Supratentorial primary neuroectodermal tumor (PNET) inside the third ventricle in adult: an rare case report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1626002 ◽

2013 ◽

Vol 32 (02) ◽

pp. 125-129

Author(s):

Tiago de Paiva Cavalcante ◽

Siegfried Pimenta Kuehnitzsch ◽

George Santos dos Passos ◽

José Eduardo Souza Dias Júnior ◽

Tobias Engel Ayer Botrel ◽

...

Keyword(s):

Case Report ◽

Emergency Room ◽

Ventriculoperitoneal Shunt ◽

Rare Case ◽

Third Ventricle ◽

Treatment Options ◽

Neurological Status ◽

The Third ◽

Rare Case Report ◽

Undifferentiated Tumors

AbstractThe PNET of CNS are considered malignant undifferentiated tumors, and it represents about 2,8% of all tumors found on infants and teenagers, more rarely found on adults. In the present article will report the case of a patient, male, 23 years-old, with nodular lesion inside the third ventricle, admitted on emergency room with acute intense headache, drowsiness, vomiting and visual clouding, started three days before. Although there have been advances in diagnosis and treatment of PNET in children, few publications were found on the efficiency of available treatment options on adults. In our patient the lesion was completely removed by a anterosuperior interhemispheric transcallosal craniotomy, and subsequently diagnosed as PNET by anatomopathological. Postoperative hydrocephaly was installed and reverted with a ventriculoperitoneal shunt, with clinical and neurological status improvement. The patient died 18 months after diagnosis, due to respiratory hospitalar infection.

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