Case report: Flattening of the tectal plate in obstructive hydrocephalus with auto-ventriculostomy

2021 ◽  
pp. 197140092110366
Author(s):  
Michael Städt ◽  
Markus Holtmannspötter ◽  
Johannes Schwab ◽  
Florian Eff ◽  
Heinz Voit-Höhne
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Aqueductal Stenosis ◽  
Chronic Obstructive ◽  
Chronic Hydrocephalus ◽  
Contrast Imaging ◽  
The Third ◽  
Tectal Plate ◽  
Flow Through ◽  
Fluid Pulsation

Background Obstructive hydrocephalus in adulthood can be caused by stenosis in the aqueductal area. Chronic changes lead to a dilatation of the lateral ventricles and ballooning of infratentorial recesses. In rare cases a rupture of the floor of the third ventricle (so-called spontaneous ventriculostomy) has been described in the literature. Case presentation: We present two cases of chronic obstructive hydrocephalus due to aqueductal stenosis in adult patients. Magnetic resonance imaging included phase-contrast-imaging and revealed significant flow through the floor of the third ventricle in keeping with spontaneous ventriculostomy. In addition to other typical changes associated with chronic hydrocephalus, a distinct flattening of the tectal plate could be identified in one case. Conclusion We present two cases of spontaneous ventriculostomy in patients with chronic hydrocephalus. To our knowledge, flattening of the tectal plate has not yet been described in the literature and may be caused by continuous cerebrospinal fluid-pulsation.

Spontaneous third ventriculostomy: definition by endoscopy and cerebrospinal fluid dynamics

2009 ◽  
Vol 111 (3) ◽  
pp. 628-631 ◽  
Author(s):  
Amit Parmar ◽  
Kristian Aquilina ◽  
Michael R. Carter
Keyword(s):  
Fluid Dynamics ◽  
Cerebrospinal Fluid ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Chronic Obstructive ◽  
Cerebrospinal Fluid Dynamics ◽  
The Third ◽  
And Function

Chronic obstructive hydrocephalus is known to cause ventricular diverticula and, rarely, spontaneous ventriculostomy. The authors present the case of a patient in whom a spontaneous third ventriculostomy was identified with long-standing hydrocephalus secondary to aqueductal stenosis. To their knowledge, this is the first report in which a spontaneous stoma in the floor of the third ventricle was evaluated using endoscopy and cerebrospinal fluid dynamics studies. Both studies confirmed that the spontaneous stoma is similar in structure and function to surgical third ventriculostomy.

scholarly journals Endoscopic treatment of a third ventricle choroid plexus cyst

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Danielle de Lara ◽  
Leo F. S. Ditzel Filho ◽  
Jun Muto ◽  
Daniel M. Prevedello
Keyword(s):  
Choroid Plexus ◽  
Obstructive Hydrocephalus ◽  
Adult Population ◽  
Third Ventricle ◽  
Postoperative Recovery ◽  
Current Treatment ◽  
Posterior Portion ◽  
Cerebrospinal Fluid Flow ◽  
Patient Reports ◽  
The Third

Choroid plexus cysts are frequent benign intraventricular lesions that infrequently cause symptoms, usually in the form of obstructive hydrocephalus. These instances are even less common in the adult population. When warranted, treatment seeks to reestablish cerebrospinal fluid flow and does not necessarily require resection of the cyst itself. Hence, endoscopic exploration of the ventricles with subsequent cyst ablation is the current treatment of choice for these lesions.Herein we present the case of a 25-year-old female patient with a 3-week history of intermittent headaches. Investigation with computerized tomography (CT) of the head detected supratentorial hydrocephalus, with enlargement of the lateral and third ventricles. Magnetic resonance imaging revealed a homogeneous cystic lesion in the third ventricle. A right-sided, pre-coronal burr hole was carried out, followed by endoscopic exploration of the ventricular system. A third-ventriclostomy was performed. With the aid of the 30-degrees endoscope, a cyst arising from the choroid plexus was visualized along the posterior portion of the third ventricle, obstructing the aqueduct opening. The cyst was cauterized until significant reduction of its dimensions was achieved and the aqueduct opening was liberated. Postoperative recovery was without incident and resolution of the hydrocephalus was confirmed by CT imaging. The patient reports complete improvement of her headaches and has been uneventfully followed since surgery.The video can be found here: http://youtu.be/XBtj_SqY07Q.

Neuroepithelial (colloid) cyst of the third ventricle in identical twins

1986 ◽  
Vol 65 (3) ◽  
pp. 401-403 ◽  
Author(s):  
Abdel Wahab M. Ibrahim ◽  
Hisham Farag ◽  
Mohammed Naguib ◽  
Ezzeldin Ibrahim
Keyword(s):  
Cerebrospinal Fluid ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Content Type ◽  
The Third ◽  
Colloid Cysts ◽  
Fluid Pathway ◽  
Ocular Signs ◽  
Fine Print

✓ Colloid cysts of the third ventricle are described in middle-aged twin brothers. One of them presented with recurrent attacks of headache. In this patient the cyst had reached a size large enough to obstruct the cerebrospinal fluid pathway, resulting in hydrocephalus. The twin brother, although asymptomatic, was suspected of the anomaly and investigated because of the similarity of his ocular signs. The diagnosis was confirmed by computerized tomography in both the patient and his brother. The latter proved to have a smaller colloid cyst situated anteriorly in the third ventricle with no obstructive hydrocephalus. The patient was successfully operated on, while the brother is still under observation. Both brothers have had bilateral cataracts, retinal detachments, and left lateral rectus palsies. The familial occurrence of colloid cysts and their association with these ocular findings have apparently not been described before.

Hematoma from arteriovenous malformation producing hydrocephalus and simulating a thalamic tumor

1971 ◽  
Vol 34 (2) ◽  
pp. 229-235 ◽  
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.

DIZYGOTIC TWINS WITH A COLLOID CYST OF THE THIRD VENTRICLE

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. E1003-E1003 ◽  
Author(s):  
Rossana Romani ◽  
Mika Niemelä ◽  
Miikka Korja ◽  
Juha A. Hernesniemi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Resonance Imaging ◽  
Transcallosal Approach ◽  
The Third ◽  
Familial Cases ◽  
Colloid Cysts

Abstract OBJECTIVE AND IMPORTANCE Colloid cysts of the third ventricle are rare benign tumors of endodermal origin accounting for 1% of all intracranial tumors. Interestingly, a few familial cases have been reported previously. We present the first case of dizygotic twins with a symptomatic colloid cyst of the third ventricle. CLINICAL PRESENTATION A 10-year-old boy was admitted to a local hospital in 1993 because of severe progressive headache. Computed tomographic and magnetic resonance imaging scans revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst, which was removed after emergent ventricular drainage. Fourteen years later, a nonidentical twin brother complained of continuous headache with nausea and vomiting. A magnetic resonance imaging scan showed obstructive hydrocephalus and a third ventricle colloid cyst, which was removed by use of the transcallosal approach. INTERVENTION Both twins underwent complete removal of the cyst by the interhemispheric transcallosal approach without postoperative complications. CONCLUSION On the basis of a literature review, 2 cases of colloid cysts of the third ventricle in monozygotic twins and a few familial cases have been reported. Our case is the first in dizygotic twin brothers. These findings suggest that the prevalence of colloid cyst may be higher in twins than in the general population. We believe that the presence of this lesion in a twin necessitates magnetic resonance imaging of the other twin, and a clinical follow-up would be recommended in all other first-degree relatives.

INTRAOPERATIVE DIRECT THIRD VENTRICULOSTOMY AND AQUEDUCTAL STENTING IN DEEP-SEATED MIDLINE BRAIN TUMOR SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 256-267 ◽  
Author(s):  
David I. Pitskhelauri ◽  
Alexander N. Konovalov ◽  
Valeri N. Kornienko ◽  
Natalia K. Serova ◽  
Nikita V. Arutiunov ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Tumor Removal ◽  
The Third ◽  
Total Tumor Removal ◽  
Ventricular Shunting

Abstract OBJECTIVE Surgical resection of deep-seated midline brain tumors does not always resolve obstruction of cerebrospinal fluid pathways, and an additional operation—ventricular shunting—is required. To prevent postoperative obstructive hydrocephalus, we combine tumor removal and internal ventricular shunting in 1 stage. METHODS Between 2000 and 2006, 82 patients with deep-seated midline brain tumors (tumors of the third ventricle, pineal region, thalamus, upper brainstem, and superior half of the fourth ventricle) underwent 84 tumor resections with intraoperative internal ventricular shunting. Two types of intraoperative shunting were performed: direct third ventriculostomy with fenestration of the premammillary membrane of the third ventricle floor and Liliequist's membrane, 53 operations; and aqueductal stenting, 30 operations. In 1 patient, third ventriculostomy and aqueductal stenting were performed simultaneously. RESULTS As most of the tumors had an infiltrative growth pattern, gross total tumor removal was achieved in only 31% of patients in this series. There were no fatal outcomes related to the surgery. Follow-up data were collected in 73 patients (89%) and ranged from 2 to 68 months (median, 16 months). Additional shunting because of inadequate function of stoma or stent was performed in 13 patients at various times after surgery (median, 30 days). The Kaplan-Meier survival analysis demonstrated that at 12 and 24 months the intraoperative direct third ventriculostomy success rates were 67 and 61%, respectively; aqueductal stenting success rates were 93% at both 12 and 24 months. CONCLUSION Intraoperative direct third ventriculostomy and aqueductal stenting under direct visual control were found to be reliable methods of hydrocephalus management in patients with deep-seated midline brain tumors.

Efficacy and Safety of Endoscopic Transventricular Lamina Terminalis Fenestration for Hydrocephalus

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 464-473 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Steven W. Hwang ◽  
Andrew Jea ◽  
Jaime Torres-Corzo
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Perioperative Complications ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Significant Risk ◽  
Good Alternative ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Lamina Terminalis ◽  
Transforaminal Approach

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has become the procedure of choice in the treatment of obstructive hydrocephalus. In certain cases, standard ETV might not be technically possible or may engender significant risk. OBJECTIVE: To present an alternative through the lamina terminalis (LT) by a transventricular, transforaminal approach with flexible neuroendoscopy and to discuss the indications, technique, neuroendoscopic findings, and outcomes. METHODS: Between 1994 and 2010, all patients who underwent endoscopic LT fenestration as an alternative to ETV were analyzed and prospectively followed up. The decision to perform an LT fenestration was made intraoperatively. RESULTS: Twenty-five patients, ranging in age from 7 months to 76 years (mean, 28.1 years), underwent endoscopic LT fenestration. Patients had obstructive hydrocephalus secondary to neurocysticercosis (11 patients), neoplasms (6 patients), congenital aqueductal stenosis (3 patients), and other (5 patients). Thirteen patients (52%) had had at least 1 ventriculoperitoneal shunt that malfunctioned; 6 patients (24%) had undergone a previous endoscopic procedure. Intraoperative findings that led to an LT fenestration were the following: ETV not feasible to perform, basal subarachnoid space not sufficient, or adhesions in the third ventricle. No perioperative complications occurred. The mean follow-up period was 63.76 months. Overall, 19 patients (76%) had resolutions of symptoms, had no evidence of ventriculomegaly, and did not require another procedure. Six (24%) required a ventriculoperitoneal shunt. CONCLUSION: Endoscopic transventricular transforaminal LT fenestration with flexible neuroendoscopy is feasible with a low incidence of complications. It is a good alternative to standard ETV. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.

Communicating hydrocephalus as a cause of aqueductal stenosis

1979 ◽  
Vol 51 (6) ◽  
pp. 812-818 ◽  
Author(s):  
G. Robert Nugent ◽  
Ossama Al-Mefty ◽  
Sam Chou
Keyword(s):  
Clinical Features ◽  
Clinical Picture ◽  
Third Ventricle ◽  
Aqueductal Stenosis ◽  
Communicating Hydrocephalus ◽  
High Grade ◽  
Content Type ◽  
Complete Occlusion ◽  
The Third ◽  
Fine Print

✓ Eleven cases of presumed aqueductal stenosis with onset of symptoms after the first decade were reviewed. Ten patients had complete occlusion and one a high-grade stenosis. In 10, the dilated lateral ventricles caused a marked inferior displacement of the third ventricle. Postshunting diagnostic studies on six of these patients revealed ascent of the third ventricle, and in three of these the aqueduct was shown to be patent. It appears that in some cases of advanced communicating hydrocephalus the descending third ventricle kinks or pinches shut the aqueduct, adding an obstructive component which accelerates the clinical picture. The mechanism and clinical features of this process are discussed.

scholarly journals Unusual presentation of xanthogranuloma of the choroid plexus

2010 ◽  
Vol 01 (02) ◽  
pp. 097-098 ◽  
Author(s):  
Jayaprakash Shetty ◽  
KV Devadiga ◽  
Muktha Pai ◽  
Keyword(s):  
Choroid Plexus ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Unusual Presentation ◽  
Benign Tumors ◽  
The Third ◽  
Lateral Ventricles ◽  
Exact Etiology

ABSTRACTIntracranial xanthogranulomas are rare benign tumors and occur most commonly as choroid plexus xanthogranulomas, which rarely become symptomatic. Exact etiology is still a matter of debate. We present a case of xanthogranuloma of the choroid plexus of the third ventricle, causing obstructive hydrocephalus of the lateral ventricles.

scholarly journals Simulation of Bronchial Airflow in COPD Patients

2020 ◽  
Vol 14 (1) ◽  
pp. 20-27
Author(s):  
L.F. Salcedo-Hernandez ◽  
C.R. Torres-Sanmiguel ◽  
G. Urriolagoitia-Sosa ◽  
G.P. Torres-San Miguel ◽  
L.A. Aguilar-Perez ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Flow Speed ◽  
Chronic Obstructive ◽  
Internal Wall ◽  
Common Risk Factor ◽  
Obstructive Pulmonary Disease ◽  
The Third ◽  
Copd Patients ◽  
Flow Through ◽  
Fluid Interaction

Aim: This research tackles the problem of assessing airflow inside both a healthy and a COPD bronchus ramification, by a Finite Element Method (FEM) computational mode. Background: Chronic Obstructive Pulmonary Disease (COPD) is considered the third leading cause of death worldwide, smoking being the most common risk factor. In the case of emphysema, the appearance of bullae in the upper and middle lobes is frequent. Objective: Bullae tend to increase their size progressively with time, severely clogging bronchi. In this research, bullae with different sizes are modelled as semi-spheres located at the internal wall of a 3D tomographic-based bronchi model. Methods: Several numerical analyses were performed by applying fluid interaction focused on the behaviour of flow through a fifth generations bronchus bifurcation in different cases and degrees of the advance of COPD. Results: The outcome provides the gradients of flow speed and pressure within the bronchus ramification in the considered cases. Conclusion: The methodology herein proposed is applicable to determine the airflow within any patient’s bronchus bifurcation were bullae appear, and thereby to assess and improve the design of custom treatments.

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