Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position

2018 ◽  
Vol 17 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Alberto Feletti ◽  
Riccardo Stanzani ◽  
Matteo Alicandri-Ciufelli ◽  
Giuliano Giliberto ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Blood Clot ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Posterior Fossa Surgery ◽  
The Third ◽  
Blood Clots ◽  
Surgical Field

AbstractBACKGROUNDDuring surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.OBJECTIVETo illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris.METHODSWe report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker.RESULTSA large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess.CONCLUSIONWe describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training.

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.

Acute obstructive hydrocephalus caused by a migrating intraventricular calculus

1993 ◽  
Vol 78 (5) ◽  
pp. 826-828 ◽  
Author(s):  
En-Chow Tan ◽  
Takuji Takagi ◽  
Seiji Matsuura ◽  
Shiro Mizuno
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Lateral Ventricle ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Ventricular Drainage ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ A 10-year-old boy presented with acute obstructive hydrocephalus caused by the impaction of a calculus on the cerebral aqueduct. The calculus migrated from the third ventricle to the fourth ventricle after ventricular drainage and right ventriculoperitoneal shunt placement had been performed. The nature and origin of the calculus could not be determined, although its release from the choroid plexus in the lateral ventricle is highly possible.

scholarly journals Blockade of the cerebral aqueduct in rats provides evidence of antagonistic leptin responses in the forebrain and hindbrain

2014 ◽  
Vol 306 (4) ◽  
pp. E414-E423 ◽  
Author(s):  
Michael I. Vaill ◽  
Bhavna N. Desai ◽  
Ruth B. S. Harris
Keyword(s):  
Weight Loss ◽  
Food Intake ◽  
Body Fat ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Sprague Dawley ◽  
Leptin Receptors ◽  
The Third ◽  
Inhibit Food Intake

Previously, we reported that low-dose leptin infusions into the fourth ventricle produced a small but significant increase in body fat. These data contrast with reports that injections of higher doses of leptin into the fourth ventricle inhibit food intake and weight gain. In this study, we tested whether exogenous leptin in the fourth ventricle opposed or contributed to weight loss caused by third ventricle leptin infusion by blocking diffusion of CSF from the third to the fourth ventricle. Male Sprague-Dawley rats received third ventricle infusions of PBS or 0.3 μg leptin/24 h from miniosmotic pumps. After 4 days, rats received a 3-μl cerebral aqueduct injection of saline or of thermogelling nanoparticles (hydrogel) that solidified at body temperature. Third ventricle leptin infusion inhibited food intake and caused weight loss. Blocking the aqueduct exaggerated the effect of leptin on food intake and weight loss but had no effect on the weight of PBS-infused rats. Leptin reduced both body fat and lean body mass but did not change energy expenditure. Blocking the aqueduct decreased expenditure of rats infused with PBS or leptin. Infusion of leptin into the third ventricle increased phosphorylated STAT3 in the VMHDM of the hypothalamus and the medial NTS in the hindbrain. Blocking the aqueduct did not change hypothalamic p-STAT3 but decreased p-STAT3 in the medial NTS. These results support previous observations that low-level activation of hindbrain leptin receptors has the potential to blunt the catabolic effects of leptin in the third ventricle.

Critical surgical anatomy of the ventricular system

2010 ◽  
pp. 674-680
Author(s):  
George Samandouras
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Surgical Anatomy ◽  
Ventricular System ◽  
The Third ◽  
Lateral Ventricles ◽  
System P

Chapter 12.1 covers critical surgical anatomy of the ventricular system, including brief surgical embryology, brief clinical histology, the lateral ventricles, the third ventricle, the fourth ventricle, and major cisterns.

scholarly journals III. Contributions to the anatomy of the central nervous system in vertebrated animals. Part I.—Ichthyopsida. Section I.—Pisces. Subsection III.—Dipnoi. On the brain of the Ceratodus forsteri

1888 ◽  
Vol 43 (258-265) ◽  
pp. 420-423
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Pia Mater ◽  
The Third ◽  
Lateral Ventricles ◽  
Large Size ◽  
General Arrangement ◽  
Tela Choroidea ◽  
The Central Nervous System ◽  
The Brain

The brain of Ceratodus has the following general arrangement:—The membrane which represents the pia mater is of great thickness and toughness; there are two regions where a tela choroidea is developed: one where it covers in the fourth ventricle, and the other where it penetrates through the third ventricle and separates the lateral ventricles from each other. The ventricles are all of large size, and the walls of the lateral ventricles are not completed by nervous tissue. The thalamence-phalon and the mesencephalon are narrow, and the medulla oblongata is wide.

Organization of the Vascular Supply to the Brain of the Toad Bufo-Marinus

1990 ◽  
Vol 38 (4) ◽  
pp. 375
Author(s):  
GK Snyder ◽  
B Gannon ◽  
RV Baudinette
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Vascular Supply ◽  
Bufo Marinus ◽  
Cane Toad ◽  
The Third ◽  
Toad Bufo ◽  
The Brain ◽  
Caudal Rami ◽  
Vascular Corrosion Casts

The vasculature of the brain of the cane toad, Bufo marinus, was studied by means of scanning electron microscopy of vascular corrosion casts. The sole arterial supply to the brain is from branches of the internal carotids. The forebrain is supplied by several branches from the rostra1 ramus of the carotids; the caudal ramus gives rise to a single branch which supplies the mesencephalon and cerebellum. The caudal rami fuse to form a single basilar artery which supplies the medulla. The vascular supply to the choroid plexus of the third ventricle is arterial; the vascular supply to the choroid of the fourth ventricle is entirely venous. Microvascular geometry in the toad brain is specific to the region of the brain examined, ranging from simple long capillaries with few anastomotic connections to much shorter, highly convoluted capillaries with many anastomotic connections.

Intraventricular meningiomas: a clinicopathological study and review of the literature

2006 ◽  
Vol 20 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Harjinder S. Bhatoe ◽  
Prakash Singh ◽  
Vibha Dutta
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Neurofibromatosis Type ◽  
Histopathological Features ◽  
The Third ◽  
Lateral Ventricles ◽  
Suboccipital Craniectomy ◽  
Eloquent Cortex ◽  
Slow Growing

Object Intraventricular meningiomas are rare tumors. The origin of these tumors can be traced to embryological invagination of arachnoid cells into the choroid plexus. The authors analyzed data that they had collected to study the clinicopathological aspects and review the origin, presentation, imaging, and management of these tumors. Methods In this retrospective analysis, the authors describe the cases of 12 patients who had received a diagnosis of intraventricular meningioma and underwent surgery for the tumors. Nine of these patients were men and three were women. Features of neurofibromatosis Type 2 were present in two of the women. Nine of the tumors were located in the lateral ventricles, one was in the third ventricle, and two were in the fourth ventricle. Raised intracranial pressure (ICP) was the universal presentation in all the patients, and the preoperative diagnoses were confirmed on neuroimaging studies. Excision was performed using the parietooccipital (trigonal) approach for lateral ventricle tumors, the transcortical–transventricular route for the third ventricle tumor, and suboccipital craniectomy for fourth ventricle tumors. Postoperatively, one patient died and the others experienced resolution of their symptoms. Histopathological features of these tumors were similar to those seen in meningiomas in other locations. Conclusions Intraventricular meningiomas are slow-growing tumors that become large prior to detection. Although they are commonly seen in the lateral ventricles, they occur in the third and fourth ventricles as well. Presentation is in the form of raised ICP with no localizing features; therefore the diagnosis is based on imaging studies. Hydrocephalus occurs due to obstruction of cerebrospinal fluid pathways. Excision requires planning to avoid eloquent cortex incision. The histopathological features are varied, although most of the tumors in the study were angiomatous meningiomas. These tumors are no different histologically from tumors that are dural in origin. No recurrence has been reported.

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