Trapped Fourth Ventricle Phenomenon Following Aneurysm Rupture of the Posterior Circulation

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 253-258 ◽  
Author(s):  
Manuel Ferreira ◽  
Brian V. Nahed ◽  
Maya A. Babu ◽  
Brian P. Walcott ◽  
Richard G. Ellenbogen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Case Series ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Shunt System ◽  
Cerebrospinal Fluid Diversion ◽  
Isolated Fourth Ventricle ◽  
Posterior Circulation Aneurysms ◽  
Trapped Fourth Ventricle

Abstract BACKGROUND AND IMPORTANCE Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. CLINICAL PRESENTATION A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. CONCLUSION Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. 340-347 ◽  
Author(s):  
Eytan Raz ◽  
Maksim Shapiro ◽  
Razvan Buciuc ◽  
Peter Kim Nelson ◽  
Erez Nossek
Keyword(s):  
Case Series ◽  
Vascular Anatomy ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Femoral Access ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment ◽  
Posterior Circulation Aneurysm ◽  
Device Placement ◽  
Posterior Circulation Aneurysms

AbstractBACKGROUNDThe treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route.OBJECTIVETo describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access.METHODSWe collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment.RESULTSA total of four patients were treated. TRA was useful in the setting of extreme vessel tortuosity. We utilized 5F Terumo Glidesheath (Terumo Medical, Somerset, New Jersey), intermediate catheter, and a 027 microcatheter for Pipeline deployment. TRA was not associated with any access or deployment difficulties.CONCLUSIONSEarly experience suggests that TRA for Pipeline Embolization Device placement for posterior circulation aneurysm is a safe and efficient alternative to standard transfemoral access. While this approach was initially applied to patients with vascular anatomy that may not allow for safe femoral access or navigation, experience so far argues for considering a radial approach towards some posterior circulation aneurysm treatment.

Isolated Fourth Ventricle: To Shunt or Stent

2017 ◽  
Vol 14 (5) ◽  
pp. 483-493 ◽  
Author(s):  
Aaron Mohanty ◽  
Kim Manwaring
Keyword(s):  
Fourth Ventricle ◽  
Aqueductal Stenosis ◽  
Stent Migration ◽  
Complication Rates ◽  
Management Options ◽  
Cerebrospinal Fluid Diversion ◽  
Isolated Fourth Ventricle ◽  
Nerve Paresis ◽  
Preoperative Magnetic Resonance

Abstract BACKGROUND Of the various management options for isolated fourth ventricle (IFV), fourth ventriculoperitoneal shunts (FVPS) and aqueductal stents (AST) have been the most favored. Though effective, FVPS are often difficult to place and have higher complication rates than conventional ventricular shunts. OBJECTIVE To assess the efficacy of AST in IFV and compare the outcome with FVPS. METHODS Twenty-five patients surgically treated for IFV were analyzed. In all, a preoperative magnetic resonance imaging assessed the extent of aqueductal obstruction. Patients with an identified short-segment aqueductal stenosis were considered for AST placement; those with long-segment aqueductal obstruction underwent FVPS. RESULTS Of the 25, 12 were symptomatic, while 13 were asymptomatic (progressive dilation of IFV in 9, persistent dilation with distortion of the brain stem in 4). In 3 with normal ventricles, the ventricles had to be dilated by externalizing the shunt before placing the stent. Nineteen underwent AST placement, whereas in 6 FVPS was performed. Sixteen patients underwent a simultaneous cerebrospinal fluid diversion procedure and fourth ventricular decompression. At follow-up (mean: 45 mo), stent migration was observed in 2 patients. In the FVPS group, 1 had 2 shunt revisions while another developed reversible cranial nerve paresis. Though a reduction of the IFV was observed with both procedures, the extent of reduction was more with FVPS. CONCLUSION Both FVPS and AST are effective in managing IFV. The extent of aqueductal obstruction and degree of ventriculomegaly are often the deciding factors in choosing the management option.

scholarly journals The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

2016 ◽  
Vol 125 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Ning Lin ◽  
Ashish Sonig ◽  
Ansaar T. Rai ◽  
Jeffrey S. Carpenter ◽  
...  
Keyword(s):  
Case Series ◽  
Dissecting Aneurysm ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Single Center Experience ◽  
Vertebrobasilar Artery ◽  
Delayed Hemorrhage ◽  
Posterior Circulation Aneurysms ◽  
Previously Treated

OBJECT Pessimism exists regarding flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures. The authors report the results of patients who underwent Pipeline Embolization Device (PED) flow diversion using novel strategies for treatment of fusiform posterior circulation aneurysms, and compare these results with those from previously reported series. METHODS The authors conducted a retrospective review of data from consecutive patients with fusiform vertebrobasilar artery aneurysms treated with the PED. RESULTS This review resulted in the identification of 12 such patients (mean [± SD] age 55.1 ± 14.1 years). Eleven patients had symptoms; 1 had a dissecting aneurysm identified on imaging for neck pain. The average aneurysm size was 13.25 ± 4.5 mm. None of the aneurysms were ruptured or previously treated. The average clinical follow-up duration was 22.1 ± 10.7 months and radiological follow-up was 14.5 ± 11.1 months from the index PED treatment. One patient suffered a perforator stroke and had a modified Rankin Scale (mRS) score of 4 at last follow-up. Another patient had a retained stent pusher requiring retrieval via surgical cut-down but recovered to an mRS score of 0 at last follow-up. Eleven (91.7%) of 12 patients recovered to an mRS score of 0 or 1. Two patients had aneurysmal remnants at 7 and 10 months, respectively, after the index PED, which were retreated with PEDs. At last follow-up, all 12 aneurysms were occluded and PEDs were patent. The minimum follow-up duration was 12 months from the index PED treatment; no patient experienced delayed hemorrhage, stroke, or in-stent stenosis. CONCLUSIONS Flow diversion with selective adjunctive techniques is evolving to become a safer treatment option for posterior circulation aneurysms. This is the longest clinical follow-up duration reported for a single-center experience of flow-diversion treatment of these aneurysms.

Sialorrhea from fourth ventricle hydrocephalus

1994 ◽  
Vol 81 (2) ◽  
pp. 297-298 ◽  
Author(s):  
Stefania Filippi ◽  
Pierfrancesco Monaco ◽  
Umberto Godano ◽  
Fabio Calbucci
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Content Type ◽  
Main Symptom ◽  
Cerebrospinal Fluid Diversion ◽  
Fine Print

✓ The case of a 50-year-old man with tetraventricular hypertensive hydrocephalus is presented, remarkable for fourth ventricle dilatation. This patient showed a significant sialorrhea as the main symptom, which is quite unusual. This condition was successfully treated by cerebrospinal fluid diversion. The uncommon features of this case are summarized.

Endoscope-assisted placement of a multiperforated shunt catheter into the fourth ventricle via a frontal transventricular approach

2007 ◽  
Vol 22 (4) ◽  
pp. 1-8 ◽  
Author(s):  
Kristen Upchurch ◽  
Murisiku Raifu ◽  
Marvin Bergsneider
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Flexible Endoscope ◽  
Catheter Placement ◽  
Cerebral Aqueduct ◽  
Frameless Stereotaxy ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Shunt Catheter ◽  
Isolated Fourth Ventricle

Object Patients with symptomatic isolated fourth ventricle and multicompartmentalized hydrocephalus benefit from operative treatment, but the optimal surgical approach and technique have yet to be established. The authors report on their experience with the treatment of symptomatic adult patients by endoscope-assisted placement of a fourth ventricle shunt catheter via a frontal transventricular approach. Methods The authors describe a retrospective series of four patients treated for isolated fourth ventricle. The surgical technique is described in detail: use of a flexible endoscope with dual-port intraventricular access for direct visualization and for mechanical manipulation of a multiperforated panventricular catheter guided by frameless stereotaxy. The transventricular approach allowed optimal catheter placement within the fourth ventricle. The use of the flexible endoscope permitted the neurosurgeon to use the endoscope as a tool to guide the ventricular catheter tip within the third ventricle and through the cerebral aqueduct. Clinical outcomes demonstrated neurological and radiographically verified improvement in all patients. Conclusions The endoscope-assisted dual-port technique provides a solution to the technical difficulties of fourth ventricle shunt placement. The multiple advantages of this technique include a single ventricular catheter shunt system that equalizes ventricular pressures, a frontal location for the ventricular catheter that facilitates valve placement and programming, and ventricular catheter placement within the fourth ventricle that does not allow the catheter to impinge on the fourth ventricle floor and makes the catheter less prone to obstruction.

scholarly journals Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

2017 ◽  
Vol 75 (7) ◽  
pp. 433-438 ◽  
Author(s):  
José Roberto Tude Melo ◽  
Rosane Klein Passos ◽  
Marcelo Liberato Coelho Mendes de Carvalho
Keyword(s):  
Cerebrospinal Fluid ◽  
Birth Weight ◽  
Ventriculoperitoneal Shunt ◽  
Case Series ◽  
Posthemorrhagic Hydrocephalus ◽  
Premature Neonates ◽  
Cerebrospinal Fluid Diversion ◽  
Csf Drainage ◽  
Csf Diversion ◽  
Preterm Newborns

ABSTRACT Objective The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.

Flow-related posterior cerebral artery aneurysms with internal carotid artery occlusions: An institutional series

2021 ◽  
pp. 159101992110017
Author(s):  
Waleed Butt ◽  
Luqman Malik ◽  
Permesh Singh Dhillon ◽  
Norman McConachie
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
De Novo ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Posterior Circulation ◽  
Surveillance Strategy ◽  
Posterior Circulation Aneurysms

Background Aneurysm formation after internal carotid artery (ICA) occlusion has been described in animal models and human case series with alteration of cerebral blood flow dynamics considered an aetiological risk factor. Such de novo aneurysms have seldom been described in the posterior cerebral artery (PCA) with the majority observed in the anterior circulation collateral pathways. Methods We retrospectively reviewed our institutional database of posterior circulation aneurysms in patients with iatrogenic, atherosclerotic or congenital ICA occlusions. A comprehensive review of the online literature using the PubMed and Medline databases was performed to identify previous cases of PCA aneurysms that were considered ‘flow-related’. Results We present five patients with symptomatic or ruptured PCA aneurysms with ICA occlusions. Age at presentation ranged from 21-58 and aneurysm size from 3–12 mm. All cases had angiographic evidence of posterior-anterior flow via the ipsilateral posterior communicating artery (PComA). The clinical presentation, diagnostic imaging and management strategies are further discussed. A literature review identified only two previous reported cases. Conclusion To our knowledge this is the first single centre series of posterior circulation aneurysms in patients with ICA occlusions that are considered to be ‘flow-related.’ The natural history of these rare lesions is unclear and the best management and surveillance strategy requires a patient-tailored approach by an experienced neurovascular team.

Unruptured Intradural Posterior Circulation Dissecting/Fusiform Aneurysms Natural History and Treatment Outcome

2021 ◽  
pp. 159101992110686
Author(s):  
Adam Andrew Dmytriw ◽  
Abdullah Alrashed ◽  
Alejandro Enriquez-Marulanda ◽  
Gorky Mehdi ◽  
Vitor Mendes Pereira
Keyword(s):  
Natural History ◽  
Coronary Disease ◽  
Female Gender ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Large Size ◽  
Posterior Circulation Aneurysms ◽  
Dissecting Aneurysms ◽  
Baseline Diameter

Background The natural history and outcome of unruptured posterior circulation dissecting fusiform aneurysms is not fully understood. These have a high risk of morbidity and mortality, not only due to natural history but also due to the challenging and controversial treatment approaches currently available compared to other types of intracranial aneurysms. Methods We performed a retrospective study of a prospectively collected aneurysm database at a quaternary neurovascular hospital. We included consecutive patients with unruptured intradural vertebrobasilar dissecting aneurysms between January 2000 and July 2016 who were followed to 2020. Description of baseline, procedural, and outcomes data was performed. Comparisons of patient who had aneurysm rupture on follow-up, increase in 2 or more points of mRS in follow-up and progression of the aneurysm was performed. Results Seventy patients with 78 fusiform posterior circulation aneurysms were identified. Thirty-nine (55.7%) patients were male with a mean age of 51.7 years (SD ± 17.6). When multiple, aneurysms were more likely to be fusiform (60%) than saccular (40.0%). Baseline diameter (measured on CTA/MRA/DSA), length as well as symptomatic presentation were significantly higher in aneurysms which grew over time. Coronary disease, diabetes and growth were associated an >2 increase in mRS. Diabetes as well as initial symptomatic presentation were associated with rupture. Conclusions Unruptured dissecting/fusiform aneurysm are associated with a considerable rate of rupture during follow-up. Growth is associated with morbidity even in the absence of rupture. Initial large size, coronary disease, diabetes, and to a lesser extent female gender may merit closer follow-up and/or prophylactic treatment.

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