Surgical management of intraventricular lesions

2019 ◽  
pp. 411-424
Author(s):  
Guilherme Ribas ◽  
Eduardo Ribas ◽  
Ramez W. Kirollos
Keyword(s):  
White Matter ◽  
Potential Risk ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Functional Anatomy ◽  
Deep Understanding ◽  
Neural Tissue ◽  
The Other ◽  
The Third ◽  
Shortest Route

Deep understanding of neuroanatomy is mandatory in planning and execution of surgery for intraventricular lesions. These operative procedures include both open and endoscopic approaches, and choosing the appropriate trajectory to the various parts of the ventricles can minimize the resulting morbidity of the approach, which may occur in addition to the potential risk to the surrounding structures during resection of the lesion itself. The use of the natural spaces provided by the cerebral fissures and sulci allows access to the ventricular cavities whenever possible, however, traversing neural tissue eventually is inevitable. The juxta-midline location of the frontal horns and body of the lateral ventricle and the third ventricle allows the use of interhemispheric approaches. On the other hand, transcortical/trans-sulcal approaches are necessary for lesions located within the atrium or temporal horns of the lateral ventricle. In planning these approaches not only exquisite knowledge of the functional anatomy of the cortex is required, but also understanding the subcortical architecture of the white matter fibres to choose the safest rather than just the shortest route. Furthermore, appreciating the potential morbidity from injuring the surrounding intra- and peri-ventricular structures and awareness of the blind spots related to the various trajectories cannot be underestimated. Surgery for fourth ventricular lesions is covered elsewhere.

Lateral Ventricle Choroid Plexus Papilloma Extending into the Third Ventricle

2004 ◽  
Vol 40 (6) ◽  
pp. 314-316 ◽  
Author(s):  
Federico Di Rocco ◽  
Massimo Caldarelli ◽  
Giovanni Sabatino ◽  
Gianpiero Tamburrini ◽  
Concezio Di Rocco
Keyword(s):  
Choroid Plexus ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Choroid Plexus Papilloma ◽  
The Third ◽  
Plexus Papilloma

Unilateral Hydrocephalus

1940 ◽  
Vol 86 (363) ◽  
pp. 591-601
Author(s):  
R. M. Stewart
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Spinal Fluid ◽  
Entire Body ◽  
Foramen Of Monro ◽  
Small Aperture ◽  
Partial Closure ◽  
The Third ◽  
Inflammatory Conditions ◽  
Internal Hydrocephalus

A single small aperture connecting each lateral ventricle with the dorsocephalic portion of the third ventricle provides the sole means of escape for cerebro-spinal fluid, and consequently it follows that any interference with its patency will seriously retard the outward flow of ventricular fluid. Complete, or even partial, closure of the foramen leads to a rapid increase in the volume and pressure of imprisoned ventricular fluid so that a condition of internal hydrocephalus is soon established. Usually both foramina are occluded, the hydrocephalus being therefore bilateral and the ventricles more or less symmetrically enlarged. In rare instances, however, only one foramen is obstructed, in which case the dilatation will, of course, be confined to the ipsilateral ventricle. Unilateral hydrocephalus of this obstructive type is commonly caused by inflammatory conditions in the neighbourhood of the foramen, or by pedunculated tumours attached to the choroid plexus which enjoy a degree of movement sufficient to permit intermittent or permanent blockage of the foramen of Monro. It is, however, possible to find examples of unilateral hydrocephalus in which the outflow of cerebro-spinal fluid through the foramen of Monro is unimpeded, and in these the cause of the ventricular dilatation is to be sought in some diseased condition of the cerebral wall which has become so weakened as to be unable to resist even normal ventricular pressure. Such expansion may be either limited to one part of the lateral ventricle, or general, involving the entire body with its horns.

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

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.

Microsurgical removal of paraventricular cavernous angiomas

1981 ◽  
Vol 55 (2) ◽  
pp. 308-311 ◽  
Author(s):  
Eugenio Pozzati ◽  
Giulio Gaist ◽  
Massimo Poppi ◽  
Bernardino Morrone ◽  
Roberto Padovani
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Cavernous Angioma ◽  
The Other ◽  
Content Type ◽  
Cavernous Angiomas ◽  
The Third ◽  
Microsurgical Approach ◽  
The Right ◽  
Fine Print

✓ Two cases of paraventricular cavernous angiomas are presented. In one, the cavernous angioma was found in the right wall of the fourth ventricle, and in the other in the right thalamus encroaching upon the third ventricle. Both patients had onset of symptoms suggesting a tumor. Good results were obtained by the microsurgical approach to these malformations. The computerized tomography findings typical of cavernous angiomas are reviewed.

scholarly journals STMO-08 Validation of the endoscopic 5-ALA fluorescence diagnosis for intraventricular tumors

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii10-ii10
Author(s):  
Masahiro Nonaka ◽  
Junichi Takeda ◽  
Tetsuo Hashiba ◽  
Akio Asai
Keyword(s):  
Brain Tumors ◽  
Germ Cell ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Germ Cell Tumors ◽  
Metastatic Brain Tumors ◽  
Fluorescence Diagnosis ◽  
The Third ◽  
Pilocytic Astrocytomas ◽  
Intraventricular Tumors

Abstract Intraoperative 5-ALA fluorescence diagnosis (PDD) has been shown to improve tumor resection rates in surgery for malignant glioma. Recently, the usefulness of PDD has been reported in tumors other than malignant glioma. However, the fluorescence of intraventricular tumors is not easy to observe under the microscope, because excitation light could not reach enough to the deepest part of the brain. Therefore, we performed endoscopic 5-ALA fluorescence diagnosis of intraventricular tumors and evaluated its usefulness. Ten cases of intraventricular tumors were included in the study. There were 3 germ cell tumors, 2 metastatic brain tumors, 2 pilocytic astrocytomas, 1 malignant lymphoma, 1 subependymoma, and 1 medulloblastoma (recurrent). The tumors were located in the third ventricle in four cases, the lateral ventricle in three cases, the lateral ventricle and the third ventricle in two cases, and the aqueduct in one case. Tumor removal was performed in 6 cases and tumor biopsy in 4 cases. Intraoperative fluorescence could be observed in eight cases: three germ cell tumors, two metastatic brain tumors, two pilocytic astrocytomas, and one malignant lymphoma. Subependymoma and medulloblastoma did not show fluorescence. Among the cases with confirmed fluorescence, the fluorescent sites were targeted for biopsies for germ cell tumors and malignant lymphomas. For metastatic brain tumors and pilocytic astrocytomas, the extent of removal was determined at the time of removal, and the presence of residual tumor was confirmed by fluorescence after removal. Endoscopic 5-ALA fluorescence diagnosis for intraventricular tumors was useful in determining the target of biopsy or the extent of excision and in assessing residual tumors.

scholarly journals Anatomical Considerations of the Endonasal Transsphenoidal Approach

2018 ◽  
Vol 19 (2) ◽  
pp. 48-53
Author(s):  
Alvaro Campero ◽  
Abraham Campero ◽  
Carolina Martins ◽  
Alexandre Yasuda ◽  
Albert Rhoton
Keyword(s):  
Pituitary Adenoma ◽  
Third Ventricle ◽  
The Other ◽  
Transsphenoidal Approach ◽  
Lateral Expansion ◽  
Sphenoidal Sinus ◽  
The Third ◽  
Lateral Distance ◽  
Sellar Floor ◽  
Diaphragm Sellae

The sellar contents are separated from the sphenoidal sinus by a tiny sheath of bone that compris es the sellar floor, making the transsphenoidal approach the most used surgical route to intrasellar lesions. The transsphenoidal approach can be initiated in three different ways: 1) cutting the mucosa over the alveolar part of maxilla (sublabial transsphenoidal), 2) cutting along the anterior nasal mucosa adjacent to the columella (transeptal transsphenoidal), and 3) cutting the mucosa over the sphenoidal rostrum (endonasal transsphenoidal). Each cavernous sinus has four dural walls. The lateral, superior and posterior walls are composed of endosteal and periosteal dura leaflets. Unlike the other dural walls, the medial wall is formed of a single, thin dural sheath, an anatomical fact that help explains the lateral expansion of a pituitary adenoma. In the center, the diaphragm sellae has an opening through which the infundibulum courses, linking the pituitary gland to the floor of the third ventricle. The morphology of this opening is quite variable among individuals. On average, the anteroposterior distance of the diaphragm opening was 7.26 mm + 1.99 mm, varying from 3.4 mm up to 10.7 mm. The lateral distance of the diaphragm opening was 7.33 mm + 2.79 mm, varying from 2.8 mm up to 14.1 mm.

scholarly journals Cerebral equine hydatidosis in Southern Brazil

1997 ◽  
Vol 27 (2) ◽  
pp. 341-344 ◽  
Author(s):  
Jerônimo Lopes Ruas ◽  
Ana Lucia Schild ◽  
Cristina Gevehr Fernandes ◽  
João Luiz Montiel Ferreira ◽  
Gertrud Müller
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Brain Lesion ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
Southern Brazil ◽  
The Third ◽  
Morphometric Features ◽  
The Brain ◽  
Gross Examination

Equine cerebral hydatid disease is described in a 7-year-old, crossbred, female horse. Clinical signs were characterized by circling gait, pressing of head against fences or objects and motor incoordination. On gross examination of the brain the hemispheres were swollen, mainly the left one. On transversal sections, a 5cm X 7cm fluid-filled cyst was observed within the lateral ventricle of the left hemisphere. The cyst extended from the parietal to the occipital lobe, and compressed the third ventricle. There was also marked mid line deviation. Histologically, the brain lesion adjacent to the cyst, was characterized by a piogranulomatous process and vacuolization of neuropil. A diagnosis of equine hydatidosis caused by Echinococcus granulosus was made on the basis of the morphometric features of protoscolices hooks.

THE INFLUENCE OF THE CONCENTRATION OF SODIUM AND POTASSIUM IN THE CEREBROSPINAL FLUID ON THE SECRETION OF STEROIDS, INCLUDING ALDOSTERONE, FROM THE ADRENAL CORTEX

1961 ◽  
Vol 37 (4) ◽  
pp. 559-564 ◽  
Author(s):  
Nils Norman
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
The Other ◽  
Potassium Content ◽  
Fluid Mixtures ◽  
The Third ◽  
Artificial Cerebrospinal Fluid ◽  
The Right ◽  
Sodium And Potassium

ABSTRACT Two artificial cerebrospinal fluid mixtures, one having a higher than normal sodium, but lower than normal potassium content, the other having a lower than normal sodium, but higher than normal potassium content, were perfused alternately through the cerebral ventricular system of seven dogs, from the right lateral ventricle and down through the third ventricle, aqueduct and fourth ventricle. During this procedure blood was collected through the adrenal vein and the concentration of cortisol (11β, 17,12-trihydroxy-pregn-4-eme-3,20-dione), cortisone (17,21-dihydroxypregn-4-ene-3,11.20-trione), corticosterone (11β,21-dihydroxy-pregn-4-ene3,20-dione). compound S (11-dihydroxy-3,20-dioxo-pregn-4-en-18-al) and aldosterone (11β.21-dihydroxy-3,20-dioxo-pregn-4-en-18-al) determined. A gradual and marked increase in the secretion of all the cortical compounds was observed during the procedure. This pattern was not altered by changing from one of the artificial cerebrospinal fluid mixtures to the other.

Further evidence implicating prostaglandin E2 in the genesis of pyrogen fever

1988 ◽  
Vol 254 (3) ◽  
pp. R463-R469 ◽  
Author(s):  
F. Coceani ◽  
J. Lees ◽  
I. Bishai
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Temperature ◽  
Latent Period ◽  
Third Ventricle ◽  
Interleukin 1 ◽  
Transport Processes ◽  
The Other ◽  
Causative Role ◽  
The Third ◽  
Pg E2

Conscious cats were used to study the effects of endotoxin and interleukin 1 (IL 1) on levels of prostaglandin (PG) E2 and thromboxane (TX) B2 (the stable TXA2 byproduct) in cerebrospinal fluid (CSF) from the third ventricle. Pyrogens were given intravenously or intraventricularly and prostanoids were measured by radioimmunoassay. PGE2 was normally less abundant than TXB2 (mean, 37 vs. 528 pg/ml), and its level increased severalfold during the sustained fever following intravenous endotoxin (bolus) or IL 1 (bolus plus infusion). PGE2 elevation preceded the fever and was maintained thereafter. Likewise, intraventricular pyrogens promoted PGE2 formation, and their effect was also manifest during the latent period of the fever. The PGE2 metabolite, 13,14-dihydro-15-keto-PGE2, was not measurable in CSF from either afebrile or febrile animals. Basal content of PGE2, on the other hand, was higher in animals pretreated with probenecid (30 mg/kg ip or iv; 50 or 100 micrograms ivt), confirming the importance of transport processes in removing prostanoids from brain. Unlike PGE2, TXB2 levels did not change during the fever to intravenous endotoxin. TXB2 rose instead in response to intraventricular endotoxin, although the elevation did not extend beyond fever uprise. Furthermore, a TXA2 analog (ONO-11113;2 or 4 micrograms ivt) had inconsistent effects on body temperature, while a TXA2 antagonist (ONO-11120;2 micrograms ivt) did not interfere with endotoxin fever. These findings strongly support a causative role for PGE2 in the onset and progression of pyrogen fever. No evidence of a similar role was obtained for TXA2.

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