Massive Craniospinal Collagen Deposition after Persistent Postoperative Intraventricular Bleeding

Neurosurgery ◽  
1989 ◽  
Vol 24 (5) ◽  
pp. 771-775 ◽  
Author(s):  
Ronald C. Kim ◽  
Wilmier M. Talbert ◽  
Wonsick Choe ◽  
Ben H. Choi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Needle Biopsy ◽  
Obstructive Hydrocephalus ◽  
Ventricular System ◽  
Collagen Deposition ◽  
Pathological Findings ◽  
Operative Site ◽  
Intraventricular Bleeding

ABSTRACT A 39-year-old man developed persistent bleeding into the ventricular system after having undergone needle biopsy of what was presumed to be a left frontal neoplasm. He subsequently developed obstructive hydrocephalus that required shunting and died in a semivegetative state some 5/12; months later. At autopsy, although no neoplasm was identified at the operative site, there was massive collagen deposition within the ventricular system that extended into the spinal subarachnoid compartment. Although we have been able to find only three cases in the literature with detailed descriptions of similar pathological findings, we believe that our observations emphasize the potential for a complication of intraventricular and subarachnoid hemorrhage that is not widely recognized.

The subarachnoid space in congenital obstructive hydrocephalus

1971 ◽  
Vol 35 (1) ◽  
pp. 7-15 ◽  
Author(s):  
Thomas H. Milhorat ◽  
Mary K. Hammock ◽  
Roma S. Chandra
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Management ◽  
Subarachnoid Space ◽  
Obstructive Hydrocephalus ◽  
Pathological Findings ◽  
Past Infection ◽  
Content Type ◽  
Fine Print

✓ The leptomeninges of 52 patients who died with a diagnosis of congenital or early acquired obstructive hydrocephalus were examined microscopically. In each case a well-developed subarachnoid space was present and in no cases were the leptomeninges congenitally absent. Thus, the commonly held belief that the subarachnoid space may fail to develop in congenital obstructive hydrocephalus was not supported by this study. Pathological findings in the leptomeninges were common, however, and were generally related to the following factors: the severity of the hydrocephalus, the duration of the hydrocephalus, the success or failure of surgical management, past infection (both intrauterine and postnatal), and subarachnoid hemorrhage. The type of ventricular obstruction did not seem to be a significant factor. Certain embryological considerations raised by the current findings are discussed.

Feasibility of ventricular expansion postmortem: a novel laboratory model for neurosurgical training that simulates intraventricular endoscopic surgery

2009 ◽  
Vol 111 (6) ◽  
pp. 1165-1167 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
John C. Wellons ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ventricular System ◽  
Laboratory Model ◽  
Neurosurgical Procedures ◽  
Neurosurgical Training ◽  
Trendelenburg Position ◽  
Ventricular Dilation ◽  
Fresh Cadaver ◽  
Human Cadavers ◽  
History Of

Object Cadavers are often used in the teaching of various neurosurgical procedures. One aspect of this resource that has not been previously explored is the postmortem dilation of the ventricular system, which is often collapsed, for the purpose of training neurosurgeons in the use of intraventricular endoscopy. Methods Nine adult cadavers without a history of hydrocephalus or other known intracranial pathology were used for this study. Four specimens were obtained post embalming, and 5 specimens were fresh (time from death until the procedure < 5 hours). In all cadavers catheters were placed into the lateral ventricles; saline and then air were injected into the ventricles through the catheters. Ventriculostomy sites were filled with rubber stoppers, and in fresh specimens, formal embalming was performed with cadavers in the Trendelenburg position. Lastly, serial horizontal sectioning of the cranium was performed in all cadavers to verify ventricular dilation. Results None of the 4 embalmed specimens were found to have ventriculomegaly following injection. However, this condition was found in 4 of the 5 fresh specimens. In the single fresh cadaver without ventriculomegaly, the cause of death had been massive intracranial subarachnoid hemorrhage, which distorted the ventricular system. This may have prevented cannulation of the ventricle and ventricular expansion in this specimen. Conclusions The ventricular system of fresh human cadavers can be dilated postmortem. The method described herein may be useful to neurosurgical trainees or those trained neurosurgeons wishing to practice intraventricular endoscopy.

scholarly journals Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

2018 ◽  
Vol 128 (4) ◽  
pp. 1032-1036 ◽  
Author(s):  
Ha Son Nguyen ◽  
Luyuan Li ◽  
Mohit Patel ◽  
Shekar Kurpad ◽  
Wade Mueller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Intraventricular Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Ventricular System ◽  
Fisher Grade ◽  
Gcs Score

OBJECTIVEThe presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores.METHODSThe authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1–3 and 4–5 subgroups for analysis.RESULTSOn univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895–0.979), GCS score (OR 3.422, 95% CI 1.9–6.164), and ventricular density (OR 0.937, 95% CI 0.878–0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1–3 and 4–5.CONCLUSIONSThis study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

scholarly journals Chronic Encapsulated Expanding Thalamic Hematoma Associated with Obstructive Hydrocephalus following Radiosurgery for a Cerebral Arteriovenous Malformation: A Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Jun Takei ◽  
Toshihide Tanaka ◽  
Yohei Yamamoto ◽  
Akihiko Teshigawara ◽  
Satoru Tochigi ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Parietal Lobe ◽  
Obstructive Hydrocephalus ◽  
Chronic Subdural Hematoma ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Pathological Findings ◽  
High Concentration ◽  
Unique Type ◽  
Truncal Ataxia

Chronic encapsulated intracerebral hematoma is a unique type of intracerebral hematoma accompanied by a capsule that is abundant in fragile microvasculature occasionally causing delayed regrowth. A 37-year-old man who had undergone radiosurgery for an arteriovenous malformation (AVM) causing intracerebral hematoma in the left parietal lobe presented with headache, vomiting, and progressive truncal ataxia due to a cystic lesion that had been noted in the left thalamus, leading to progressive obstructive hydrocephalus. He underwent left frontal craniotomy via a transsylvian fissure approach, and the serous hematoma was aspirated. The hematoma capsule was easy to drain and was partially removed. Pathological findings demonstrated angiomatous fibroblastic granulation tissue with extensive macrophage invasion. The concentration of vascular endothelial growth factor (VEGF) was high in the hematoma (12012 pg/mL). The etiology and pathogenesis of encapsulated hematoma are unclear, but the gross appearance and pathological findings are similar to those of chronic subdural hematoma. Based on the high concentration of VEGF in the hematoma, expansion of the encapsulated hematoma might have been caused by the promotion of vascular permeability of newly formed microvasculature in the capsule.

Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

1999 ◽  
Vol 90 (1) ◽  
pp. 153-155 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Rolf W. Warzok ◽  
Jamal A. Assaf ◽  
Michael R. Gaab
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Balloon Catheter ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Content Type ◽  
Tomography Scanning ◽  
Fine Print

✓ In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy.This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic—peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later.Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mammillary bodies, just behind the dorsum sellae.

scholarly journals Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

1999 ◽  
Vol 6 (4) ◽  
pp. E6 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Rolf W. Warzok ◽  
Jamal A. Assaf ◽  
Michael R. Gaab
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Balloon Catheter ◽  
External Ventricular Drainage ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Tomography Scanning

In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy. This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later. Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mamillary bodies, just behind the dorsum sellae.

Obstructive hydrocephalus due to a third ventricular neuroepithelial cyst

2008 ◽  
Vol 1 (6) ◽  
pp. 481-484 ◽  
Author(s):  
D. Ryan Ormond ◽  
Ibrahim Omeis ◽  
Avinash Mohan ◽  
Raj Murali ◽  
Prithvi Narayan
Keyword(s):  
Cystic Lesion ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Definitive Diagnosis ◽  
Minor Trauma ◽  
Pathological Findings ◽  
Resonance Imaging ◽  
Outflow Obstruction ◽  
The Third ◽  
Contrast Ventriculography

✓ Cysts occupying the third ventricle are rare lesions and may appear as an unusual cause of obstructive hydrocephalus. Various types of lesions occur in this location, and they generally have an arachnoidal, endodermal, or neuroepithelial origin. The authors present a case of acute hydrocephalus following minor trauma in a child due to cerebrospinal fluid outflow obstruction by a third ventricular cyst. Definitive diagnosis of this cystic lesion was possible only with contrast ventriculography and not routine computed tomography or magnetic resonance imaging. The investigation, treatment, and pathological findings are discussed.

Massive craniospinal collagen deposition after persistent postoperative intraventricular bleeding

Neurosurgery ◽  
1989 ◽  
Vol 24 (5) ◽  
pp. 771???5
Author(s):  
R C Kim ◽  
W M Talbert ◽  
W Choe ◽  
B H Choi
Keyword(s):  
Collagen Deposition ◽  
Intraventricular Bleeding
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