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.

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.

Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy

2005 ◽  
Vol 103 (5) ◽  
pp. 848-852 ◽  
Author(s):  
Mahmoud Hamdy Kamel ◽  
Michael Kelleher ◽  
Kristian Aquilina ◽  
Chris Lim ◽  
John Caird ◽  
...  
Keyword(s):  
Predictive Value ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Fluid Pressure ◽  
Third Ventriculostomy ◽  
Content Type ◽  
The Third ◽  
The Relationship ◽  
Ventricular Reservoir ◽  
Fine Print

Object. Neuroendoscopists often note pulsatility or flabbiness of the floor of the third ventricle during endoscopic third ventriculostomy (ETV) and believe that either is a good indication of the procedure's success. Note, however, that this belief has never been objectively measured or proven in a prospective study. The authors report on a simple test—the hydrostatic test—to assess the mobility of the floor of the third ventricle and confirm adequate ventricular flow. They also analyzed the relationship between a mobile floor (a positive hydrostatic test) and prospective success of ETV. Methods. During a period of 3 years between July 2001 and July 2004, 30 ETVs for obstructive hydrocephalus were performed in 22 male and eight female patients. Once the stoma had been created, the irrigating Ringer lactate solution was set at a 30-cm height from the external auditory meatus, and the irrigation valve was opened while the other ports on the endoscope were closed. The ventricular floor ballooned downward and stabilized. The irrigation valve was then closed and ports of the endoscope were opened. The magnitude of the upward displacement of the floor was then assessed. Funneling of the stoma was deemed to be a good indicator of floor mobility, adequate flow, and a positive hydrostatic test. All endoscopic procedures were recorded using digital video and recordings were subsequently assessed separately by two blinded experienced neuroendoscopists. Patients underwent prospective clinical follow up during a mean period of 11.2 months (range 1 month–3 years), computerized tomography and/or magnetic resonance imaging studies of the brain, and measurements of cerebrospinal fluid pressure through a ventricular reservoir when present. Failure of ETV was defined as the subsequent need for shunt implantation. The overall success rate of the ETV was 70% and varied from 86.9% in patients with a mobile stoma and a positive hydrostatic test to only 14.2% in patients with a poorly mobile floor and a negative test (p < 0.05). The positive predictive value of the hydrostatic test was 86.9%, negative predictive value 85.7%, sensitivity 95.2%, and specificity 66.6%. Conclusions. The authors concluded that the hydrostatic test is an easy, brief test. A positive test result confirms a mobile ventricular floor and adequate flow through the created ventriculostomy. Mobility of the stoma is an important predictor of ETV success provided that there is no obstruction at the level of the arachnoid granulations or venous outflow. A thin, redundant, mobile third ventricle floor indicates a longstanding pressure differential between the third ventricle and the basal cisterns, which is a crucial factor for ETV success. A positive hydrostatic test may avert the need to insert a ventricular reservoir, thus avoiding associated risks of infection.

Third ventricle germinoma after total removal of intrasellar teratoma

1992 ◽  
Vol 77 (4) ◽  
pp. 643-647 ◽  
Author(s):  
Sándor Czirják ◽  
Emil Pásztor ◽  
Felicia Slowik ◽  
György Szeifert
Keyword(s):  
Germ Cells ◽  
Third Ventricle ◽  
Relevant Literature ◽  
Germ Cell Tumors ◽  
Total Removal ◽  
Unique Case ◽  
Content Type ◽  
The Third ◽  
The Brain ◽  
Fine Print

✓ A unique case is presented of a third ventricle germinoma developing 3 years after total removal of an intrasellar teratoma. The third ventricle germinoma was not considered to be a recurrence or dissemination of the mature intrasellar teratoma but to have been transformed from multicenter germ cells present in the midline of the brain with different temporal development. The relevant literature is reviewed and the problems of management of patients with germ-cell tumors are discussed.

Xanthogranuloma of the third ventricle

1979 ◽  
Vol 51 (4) ◽  
pp. 565-568 ◽  
Author(s):  
Ivar Szper ◽  
Shizuo Oi ◽  
Jan Leestma ◽  
Kwan Soo Kim ◽  
Nicholas E. Wetzel
Keyword(s):  
Third Ventricle ◽  
Complete Recovery ◽  
Autopsy Finding ◽  
Review Of The Literature ◽  
Total Removal ◽  
Geriatric Population ◽  
Content Type ◽  
The Third ◽  
History Of ◽  
Fine Print

✓ The case history of a patient with a xanthogranuloma of the third ventricle is presented. This type of lesion formed by desquamation of epithelium is usually noted as an incidental autopsy finding in the choroid plexus of the lateral ventricles. Total removal via a transcortical transventricular route led to complete recovery. These tumors should be suspected in the geriatric population. The computerized tomography findings and a review of the literature are included.

Treatment of intermittent obstructive hydrocephalus secondary to a choroid plexus cyst

2009 ◽  
Vol 4 (6) ◽  
pp. 571-574 ◽  
Author(s):  
Tanya Z. Filardi ◽  
Laura Finn ◽  
Patrik Gabikian ◽  
Carlo Giussani ◽  
Sudesh Ebenezer ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Mr Images ◽  
Constructive Interference ◽  
Head Ct ◽  
The Third ◽  
History Of ◽  
Choroid Plexus Cyst ◽  
Endoscopic Fenestration

The authors present the case of an 11-week-old girl in whom hydrocephalus developed secondary to intermittent obstruction of the third ventricle by a choroid plexus cyst. The patient presented to the emergency department at the authors' institution with a 1-day history of projectile vomiting, lethargy, and dysconjugate gaze. Hydrocephalus was confirmed on head CT. During hospitalization, the symptoms resolved with a decrease in ventricular size. One week later, the patient again presented with similar symptoms, and MR images with 3D-constructive interference in steady state sequences revealed that a cyst was blocking the third ventricle. The patient subsequently underwent endoscopic fenestration of the cyst with resolution of hydrocephalus and symptoms. The authors present a unique description of the diagnosis of intermittent obstructive hydrocephalus caused by a third ventricular region choroid plexus cyst in an infant.

Endoscopic management of cysticercal cysts within the lateral and third ventricles

2000 ◽  
Vol 92 (1) ◽  
pp. 14-23 ◽  
Author(s):  
Marvin Bergsneider ◽  
Langston T. Holly ◽  
Jae Hong Lee ◽  
Wesley A. King ◽  
John G. Frazee
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Endoscopic Approach ◽  
Endoscopic Management ◽  
Third Ventriculostomy ◽  
General Description ◽  
Content Type ◽  
The Third ◽  
Lateral Ventricles ◽  
Fine Print

Object. In this report the authors review their 3-year experience with the endoscopic management of patients with hydrocephalus who harbored cysticercal cysts within the third and lateral ventricles. The management plan was to utilize an endoscopic approach to remove the cysts and to incorporate techniques useful in treating obstructive hydrocephalus. The ultimate goals were to avoid having to place a complication-prone cerebrospinal fluid shunt and to eliminate the risk of complications related to cyst degeneration.Methods. A retrospective analysis of 10 patients with hydrocephalus and cysticercal cysts within the third or lateral ventricles who were endoscopically managed was performed. A general description of the instrumentation and technique used for removal of the intraventricular cysts is given. At presentation, neuroimaging revealed findings suggestive of obstructive hydrocephalus in eight patients.Seven of the 10 patients treated endoscopically were spared the necessity of shunt placement. Three successful third ventriculostomies and one therapeutic septum pellucidotomy were performed. Despite frequent rupture of the cyst walls during removal of the cysts, there were no cases of ventriculitis. The endoscopic approach allowed successful removal of a cyst situated in the roof of the anterior third ventricle. One patient suffered from recurrent shunt obstructions secondary to a shunt-induced migration of cysts from the posterior fossa to the lateral ventricles.Conclusions. The endoscopic removal of third and lateral ventricle cysticercal cysts, combined with a third ventriculostomy or septum pellucidotomy in selected cases, is an effective treatment in patients with hydrocephalus and should be considered the primary treatment for this condition.

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.

Natural history of asymptomatic colloid cysts of the third ventricle

1999 ◽  
Vol 91 (3) ◽  
pp. 364-369 ◽  
Author(s):  
Bruce E. Pollock ◽  
John Huston
Keyword(s):  
Natural History ◽  
Third Ventricle ◽  
Benign Tumors ◽  
Content Type ◽  
The Third ◽  
History Of ◽  
Colloid Cysts ◽  
The Mean ◽  
Fine Print

Object. To determine the natural history of colloid cysts of the third ventricle in patients in whom the cysts were incidentally discovered, the authors retrospectively reviewed cases observed during the modern neuroimaging era (1974–1998).Methods. During this 25-year interval, 162 patients with colloid cysts were examined and cared for at our center. Sixty-eight patients (42%) were thought to be asymptomatic with regard to their colloid cyst and observation with serial neuroimaging was recommended. The mean patient age was 57 years at the time of diagnosis (range 7–88 years) and the mean cyst size was 8 mm (range 4–18 mm). Computerized tomography scanning revealed a hyperdense cyst in 49 (84%) of 58 patients. Three patients were excluded from the study because they died of unrelated causes within 6 months of scanning and seven patients were lost to follow-up review. Clinical follow-up evaluation was available at a mean of 79 months (range 7–268 months) in the remaining 58 patients. The numbers of patients who participated in follow-up review at 2, 5, and 10 years after diagnosis were 40, 28, and 14, respectively. The incidences of symptomatic progression related to the cyst were 0%, 0%, and 8% at 2, 5, and 10 years, respectively. No patient died suddenly during the follow-up interval. Two (6%) of 34 patients in whom follow-up imaging was performed either exhibited cyst growth (one patient) or experienced hydrocephalus (one patient) at a mean of 41 months after diagnosis (range 4–160 months).Conclusions. Patients in whom asymptomatic colloid cysts are diagnosed can be cared for safely with observation and serial neuroimaging. If a patient becomes symptomatic, the cyst enlarges, or hydrocephalus develops, prompt neurosurgical intervention is necessary to prevent the occurrence of neurological decline from these benign tumors.

scholarly journals Natural history of colloid cysts of the third ventricle

2016 ◽  
Vol 125 (6) ◽  
pp. 1420-1430 ◽  
Author(s):  
Thomas L. Beaumont ◽  
David D. Limbrick ◽  
Keith M. Rich ◽  
Franz J. Wippold ◽  
Ralph G. Dacey
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Clinical Status ◽  
Colloid Cyst ◽  
Surgical Indications ◽  
The Third ◽  
History Of ◽  
Colloid Cysts ◽  
Risk Zones ◽  
Incidental Lesions

OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-prediction model was defined using bootstrapped logistic regression. Predictive factors were then combined into a simple 5-point clinical scale referred to as the Colloid Cyst Risk Score (CCRS), and this was evaluated with receiver-operator characteristics. RESULTS The study included 163 colloid cysts, more than half of which were discovered incidentally. More than half of the incidental cysts (58%) were followed with surveillance neuroimaging (mean follow-up 5.1 years). Five patients with incidental cysts (8.8%) progressed and underwent resection. No patient with an incidental, asymptomatic colloid cyst experienced acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly half (46.2%) of symptomatic patients presented with hydrocephalus. Eight patients (12.3%) presented acutely, and there were 2 deaths due to obstructive hydrocephalus and herniation. The authors identified several factors that were strongly correlated with the 2 outcome variables and defined third ventricle risk zones where colloid cysts can cause obstructive hydrocephalus. No patient with a lesion outside these risk zones presented with obstructive hydrocephalus. The CCRS had significant predictive capacity for symptomatic clinical status (area under the curve [AUC] 0.917) and obstructive hydrocephalus (AUC 0.845). A CCRS ≥ 4 was significantly associated with obstructive hydrocephalus (p < 0.0001, RR 19.4). CONCLUSIONS Patients with incidentally discovered colloid cysts can experience both lesion enlargement and symptom progression or less commonly, contraction and symptom regression. Incidental lesions rarely cause acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly one-half of patients with symptomatic colloid cysts present with obstructive hydrocephalus, which has an associated 3.1% risk of death. The CCRS is a simple 5-point clinical tool that can be used to identify symptomatic lesions and stratify the risk of obstructive hydrocephalus. External validation of the CCRS will be necessary before objective surgical indications can be established. Surgical intervention should be considered for all patients with CCRS ≥ 4, as they represent the high-risk subgroup.

Changing concepts in the treatment of colloid cysts

1987 ◽  
Vol 66 (2) ◽  
pp. 186-191 ◽  
Author(s):  
Walter A. Hall ◽  
L. Dade Lunsford
Keyword(s):  
Third Ventricle ◽  
Ct Scanning ◽  
Morbidity Rate ◽  
Ct Guided ◽  
Content Type ◽  
Persistent Symptoms ◽  
The Third ◽  
Stereotaxic Surgery ◽  
Colloid Cysts ◽  
The University

✓ Since computerized tomography (CT) scanning became available at the University Health Center of Pittsburgh in July, 1975, 17 patients have undergone removal of colloid cysts of the third ventricle by transfrontal, transcallosal, or stereotaxic surgery. All patients presented with symptoms and signs of increased intracranial pressure; CT scanning proved to be the best neurodiagnostic test to define the colloid cysts. Since the development of CT-guided stereotaxic surgery, the authors have preferentially performed stereotaxic aspiration in seven patients; three of these subsequently required craniotomies to remove residual cysts producing persistent symptoms. The viscosity of the intracystic colloid material and/or displacement of the cyst away from the aspiration needle were reasons for unsuccessful aspiration; the CT appearance did not correlate with the ability to aspirate the lesion by the stereotaxic technique. Postoperative patency of the ventricular system was documented by intraoperative CT ventriculography performed during stereotaxic surgery. Removal of the cyst wall was not necessary. Because of the low associated morbidity rate, percutaneous stereotaxic aspiration is recommended as the initial treatment of choice for colloid cysts of the third ventricle. If stereotaxic aspiration fails and symptoms persist, craniotomy should be performed.

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