Posterior Fossa Decompression and Clot Evacuation for Fourth Ventricle Hemorrhage after Aneurysmal Rupture: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 50 (5) ◽  
pp. 1166-1167
Author(s):  
Biodun I. Ogungbo
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Posterior Fossa Decompression ◽  
Aneurysmal Rupture ◽  
Clot Evacuation

Posterior Fossa Decompression and Clot Evacuation for Fourth Ventricle Hemorrhage after Aneurysmal Rupture: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 208-211 ◽  
Author(s):  
Alfonso Lagares ◽  
Christopher M. Putman ◽  
Christopher S. Ogilvy
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
World Federation ◽  
Posterior Fossa Decompression ◽  
Aneurysmal Rupture ◽  
Risk Of Death ◽  
Dismal Prognosis ◽  
Brainstem Compression ◽  
Clot Evacuation

Abstract OBJECTIVE AND IMPORTANCE Massive intraventricular hemorrhage due to aneurysmal rupture is associated with a dismal prognosis. An intraventricular clot causing fourth ventricle dilation can cause compression to the brainstem similar to other posterior fossa masses such as cerebellar hemorrhage or infarction. The presence of fourth ventricle dilation carries a very high risk of death within 48 hours. Neither ventricular drainage nor fibrinolytic infusion has been successful in eliminating clots of the fourth ventricle. Posterior fossa decompression and direct evacuation of the clot could have good results in relieving brainstem compression caused by the clot. CLINICAL PRESENTATION A 45-year-old woman was admitted to our intensive care unit after experiencing an aneurysmal subarachnoid hemorrhage. The neurological examination at admission revealed that she was in Grade V according to the World Federation of Neurological Surgeons grading system, but brainstem reflexes were present. Computed tomographic scanning revealed a massive intraventricular hemorrhage, with fourth ventricle dilation caused by an intraventricular clot. Bilateral external ventricular drains were placed to relieve elevated intracranial pressure. Cerebral angiography revealed a 1-cm basilar tip aneurysm, which was embolized with Guglielmi detachable coils (Boston Scientific, Boston, MA) during the same procedure. INTERVENTION Given the patient's poor neurological condition, it was decided that brainstem compression should be relieved. A posterior fossa decompressive craniectomy was performed immediately after coil therapy, with direct evacuation of the intraventricular clot. The patient experienced a clear improvement in the level of consciousness and has achieved a good neurological result at early follow-up. CONCLUSION Dilation of the fourth ventricle by an intraventricular clot is a sign of brainstem compression that can be relieved by posterior fossa decompression and direct clot evacuation.

scholarly journals Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications

2015 ◽  
Vol 16 (6) ◽  
pp. 752-757 ◽  
Author(s):  
Andrew Reisner ◽  
Laura L. Hayes ◽  
Christopher M. Holland ◽  
David M. Wrubel ◽  
Meysam A. Kebriaei ◽  
...  
Keyword(s):  
At Risk ◽  
Case Report ◽  
Young Children ◽  
Posterior Fossa ◽  
Mental Status ◽  
Fourth Ventricle ◽  
Altered Mental Status ◽  
Surgical Decompression ◽  
Opioid Overdose ◽  
Posterior Fossa Decompression

In environments in which opioids are increasingly abused for recreation, children are becoming more at risk for both accidental and nonaccidental intoxication. In toxic doses, opioids can cause potentially lethal acute leukoencephalopathy, which has a predilection for the cerebellum in young children. The authors present the case of a 2-year-old girl who suffered an accidental opioid overdose, presenting with altered mental status requiring cardiorespiratory support. She required emergency posterior fossa decompression, partial cerebellectomy, and CSF drainage due to cerebellar edema compressing the fourth ventricle. To the authors’ knowledge, this is the first report of surgical decompression used to treat cerebellar edema associated with opioid overdose in a child.

Case Report of Cerebellar Endometriosis

2020 ◽  
Vol 81 (04) ◽  
pp. 372-376
Author(s):  
Michael Meggyesy ◽  
Michael Friese ◽  
Joachim Gottschalk ◽  
Uwe Kehler
Keyword(s):  
Case Report ◽  
Estrogen Receptors ◽  
Posterior Fossa ◽  
Cyst Wall ◽  
Clinical Course ◽  
Correct Diagnosis ◽  
Posterior Fossa Decompression ◽  
Chronic Hydrocephalus ◽  
Brainstem Compression ◽  
Intracranial Cysts

AbstractEndometriosis is a disorder in women which is characterized by extrauterine manifestations. We describe a case of cerebellar endometriosis in a 39-year-old woman who underwent posterior fossa decompression multiple times without establishing a correct diagnosis. Her neurologic status progressively worsened due to chronic hydrocephalus and brainstem compression by cysts. Late in the clinical course, histology from the cyst wall was taken that revealed endometriosis with clear cells and positive immunohistology for progesterone and estrogen receptors. Treatment with gestagens was started but did not improve the patient's status. In patients with chronic recurring intracranial cysts and hydrocephalus, cerebral endometriosis should be considered.

Syringobulbia in a Pediatric Population

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1147-1153 ◽  
Author(s):  
Jeremy D.W. Greenlee ◽  
Arnold H. Menezes ◽  
Bryan A. Bertoglio ◽  
Kathleen A. Donovan
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerve ◽  
Fourth Ventricle ◽  
Pediatric Population ◽  
Demographic Data ◽  
Posterior Fossa Decompression ◽  
Radiographic Findings ◽  
Presenting Symptoms ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Palsies

Abstract OBJECTIVE: To better understand the presentation, management, and outcome of syringobulbia in the pediatric age group. METHODS: The University of Iowa pediatric neurosurgery database was searched for patients under the age of 18 with a diagnosis of syringobulbia. The patients' records were retrospectively reviewed for demographic data, chief complaint and presenting symptoms, neurological and radiographic findings, treatment, outcome, and complications. Children with open neural tube defects and Chiari II malformations were excluded. RESULTS: Six pediatric patients were identified as meeting inclusion criteria. The average age at time of surgery was 14.8 years. The chief complaints were vision impairment in three children and numbness, gait instability, and headache worsened with Valsalva in one patient each. Other prominent symptoms included sleep apnea and weakness. All patients showed at least one cranial nerve dysfunction. Radiographs revealed hindbrain herniation and associated syringomyelia in all cases. Two patients had scoliosis. Treatment was posterior fossa decompression with cerebellar tonsillar shrinkage, opening of foramen of Magendie, and duraplasty. Two patients also required concomitant ventral decompression. The cavity of syringobulbia communicated with syringomyelia and the fourth ventricle in most children but was distinct from the fourth ventricle. Two patients received fourth ventricle to subarachnoid shunts. Follow-up averaged 3.2 years, and all patients clinically improved after surgery. Magnetic resonance imaging documented resolution of syringobulbia in all cases, with syringomyelia improving in all cases. There was no permanent morbidity or mortality in the series. CONCLUSION: Syringobulbia is strongly associated with Chiari malformation and syringomyelia, and patients often present because of cranial nerve palsies. Posterior fossa decompression is a safe and effective treatment.

scholarly journals A giant solid cystic inferior fourth ventricle subependymoma – Case report and literature review

2016 ◽  
Vol 30 (4) ◽  
pp. 455-460
Author(s):  
A. Giovani ◽  
Narcisa Bucur ◽  
Ana Gheorghiu ◽  
Lena Papadopol ◽  
R.M. Gorgan
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Precursor Cells ◽  
Benign Tumors ◽  
Total Resection ◽  
Who Grade ◽  
Slow Growing ◽  
Glial Precursor

Abstract Subependymomas are a rare subtype of ependymomas, slow growing WHO grade I tumors that develop either intracranial from the subependymal glial precursor cells layer of the ventricles or intramedullary. These tumors originate in the undifferentiated Subependymal layer of cells that can become either ependymocytes or astrocytes. Most of the subependymomas are located inside the fourth ventricle (50-60%). We reviewed the case of a 40 years old woman with a giant solid cystic fourth ventricle ependymoma. The patient underwent total resection of the tumor through a subociipital transvermian approach. We discussed the characteristics of these benign tumors and reviewed the literature on this subject and concluded that total resection is the treatment of choice for symptomatic Subependymomas localized in posterior fossa.

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