Hydrocephalus due to membranous obstruction of the fourth ventricle

1971 ◽  
Vol 35 (6) ◽  
pp. 672-676 ◽  
Author(s):  
A. Loren Amacher ◽  
Larry K. Page
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Clinical Findings ◽  
Posterior Fossa Tumor ◽  
Cerebellar Development ◽  
Rare Entity ◽  
Content Type ◽  
Operative Findings ◽  
Membranous Obstruction ◽  
Fine Print

✓ Four patients with hydrocephalus due to membranous obstruction of the fourth ventricle are presented. This rare entity produced radiographic and clinical findings suggestive of posterior fossa tumor. Operative findings included normal cerebellar development and a translucent membrane just above the foramen of Magendie. Etiological possibilities are discussed.

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

1995 ◽  
Vol 83 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Andrew T. Dailey ◽  
Guy M. McKhann ◽  
Mitchel S. Berger
Keyword(s):  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Posterior Fossa Tumors ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Cranial Nerve Function ◽  
Pharyngeal Musculature ◽  
Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Acute hydrocephalus in posterior fossa injury

1997 ◽  
Vol 86 (4) ◽  
pp. 629-632 ◽  
Author(s):  
Hideharu Karasawa ◽  
Hajime Furuya ◽  
Hiromichi Naito ◽  
Ken Sugiyama ◽  
Junji Ueno ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Ct Scanning ◽  
Mortality Rates ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Content Type ◽  
Acute Hydrocephalus ◽  
Significant Difference ◽  
Fine Print

✓ This is the first known report of the use of computerized tomography (CT) scanning to examine acute hydrocephalus in posterior fossa injury. Of the 1802 patients with acute head trauma treated at Funabashi Municipal Medical Center, 53 (2.9%) had suffered injury to the posterior fossa. Of these, 12 patients (22.6%) had associated acute hydrocephalus: nine patients with acute epidural hematoma (AEH) and three with intracerebellar hematoma and contusion (IH/C). There was a significant relationship between cases of AEH with hydrocephalus and supratentorial extension, hematoma thickness of 15 mm or more, and abnormal mesencephalic cisterns. In cases of IH/C, bilateral lesions and no visible fourth ventricle were significant causes of hydrocephalus. According to these results, possible mechanisms of acute hydrocephalus in posterior fossa injury may be as follows: in cases of AEH, hematoma that extends to the supratentorial area compresses the aqueduct posteriorly and causes hydrocephalus; in cases of IH/C, hematoma and contusional lesions may directly occlude the fourth ventricle and cause acute hydrocephalus. Seven patients suffering from AEH with acute hydrocephalus underwent evacuation of their hematoma without external ventricular drainage. In these cases, CT scanning showed that the hydrocephalus improved immediately after evacuation of the hematoma. Two patients suffering from IH/C with hydrocephalus underwent a procedure for evacuation of the hematoma and external ventricular drainage. The authors do not believe that ventricular drainage is necessary in treating posterior fossa AEH. However, both evacuation of the hematoma and ventricular drainage are necessary in cases of IH/C with hydrocephalus to provide the patient with every chance for survival. There was no significant difference in mortality rates when cases of AEH with acute hydrocephalus (0%) were compared with cases of AEH without hydrocephalus (7.7%). The observed mortality rates in cases of IH/C with hydrocephalus and those without hydrocephalus were 100% and 15.4%, respectively; this is statistically significant.

Rhabdomyosarcoma of the brain

1975 ◽  
Vol 43 (2) ◽  
pp. 215-221 ◽  
Author(s):  
Yasuhiko Matsukado ◽  
Akira Yokota ◽  
Touru Marubayashi
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Cerebral Hemisphere ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓The authors report a case of rhabdomyosarcoma originating in the fourth ventricle and review the eight comparable previous reports of true rhabdomyosarcoma, composed solely of mesenchymal elements. Tumors in most adults arose in the cerebral hemisphere, while those in children arose exclusively in the midline structures of the posterior fossa. The tumor in the authors' case was initially benign and well circumscribed, but within 2 years had changed into a malignant rhabdomyosarcoma. The histological documentation during the interval is presented and discussed.

Mutism after posterior fossa surgery in children

1990 ◽  
Vol 72 (6) ◽  
pp. 959-963 ◽  
Author(s):  
Luigi Ferrante ◽  
Luciano Mastronardi ◽  
Michele Acqui ◽  
Aldo Fortuna
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Speech Disorder ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Disturbance Of Consciousness ◽  
Lower Cranial Nerves ◽  
Fine Print

✓ Three patients aged 5½ to 9 years old with mutism after posterior fossa surgery are presented. The entity is discussed with a review of 15 additional previously reported cases in children aged 2 to 11 years. In all 18 patients, a large midline tumor of the posterior fossa (medulloblastoma in nine cases, astrocytoma in five, and ependymoma in four), often attached to one or both lateral recesses of the fourth ventricle, was removed. Mutism developed 18 to 72 hours after the operation (mean 41.5 hours) in patients with no disturbance of consciousness and no deficits of the lower cranial nerves or of the organs of phonation. All of these children had spoken in the first hours after surgery. The disorder lasted from 3 to 16 weeks (mean 7.9 weeks). Speech was regained after a period of dysarthria in six of the 10 cases for whom this information was available. The various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.

Primary hypertension—induced cerebellar encephalopathy causing obstructive hydrocephalus

2003 ◽  
Vol 98 (6) ◽  
pp. 1307-1311 ◽  
Author(s):  
Meg Verrees ◽  
Jose Americo Fernandes Filho ◽  
Jose I. Suarez ◽  
Robert A. Ratcheson
Keyword(s):  
Blood Pressure ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Hypertensive Crisis ◽  
Systemic Blood Pressure ◽  
Neurological Status ◽  
Systemic Blood ◽  
Content Type ◽  
Fine Print

✓ Hypertension-induced encephalopathy is a recognized pathological process commonly focused in the parietal and occipital lobes of the cerebral hemispheres. The parenchyma of the posterior fossa is infrequently involved. The authors report on two cases of isolated edema of the cerebellar hemispheres, which occurred in the setting of hypertensive crisis and led to complete obstruction of or significant impingement on the fourth ventricle and potentially lethal hydrocephalus. To the best of the authors' knowledge, these are the first reported cases of hypertensive encephalopathy centered in the posterior fossa. Two patients presented with profound decreases in neurological status subsequent to development of malignant hypertension. Imaging studies revealed diffusely edematous cerebellar hemispheres with effacement of the fourth ventricle, causing dilation of the lateral and third ventricles. Following emergency placement of external ventricular drains, control of systemic blood pressure was accomplished, and neurological functioning returned to baseline. Although neurological deterioration resolved swiftly following placement of ventricular catheters and administration of diuretic agents, systemic blood pressure did not fluctuate with the release of cerebrospinal fluid and resolution of increased intracranial pressure. Decrease in systemic blood pressure lagged well behind improvement in neurological status; the patients remained morbidly hypertensive until systemic blood pressure was controlled with multiple parenteral medications. The authors hypothesize that the development of hypertension beyond the limits of cerebral autoregulation led to breakdown of the blood—brain barrier in the cerebellum and development of posterior fossa edema secondary to the focal transudation of protein and fluid. Correction of the elevated blood pressure led to amelioration of cerebellar edema. In the appropriate clinical setting, hypertension as the inciting cause of cerebellar encephalopathy should be considered.

South American blastomycosis presenting as a posterior fossa tumor

1978 ◽  
Vol 49 (3) ◽  
pp. 425-428 ◽  
Author(s):  
João C. Araujo ◽  
Lineu Werneck ◽  
Marco A. Cravo
Keyword(s):  
Central Nervous System ◽  
Posterior Fossa ◽  
Unusual Case ◽  
Posterior Fossa Tumor ◽  
South American ◽  
Pertinent Literature ◽  
Content Type ◽  
South American Blastomycosis ◽  
The Central Nervous System ◽  
Fine Print

✓ An unusual case of infection of the central nervous system by Paracoccidioides braziliensis, presenting as posterior fossa tumor, is discussed and the pertinent literature reviewed.

Symptomatic subependymoma of the fourth ventricle

1981 ◽  
Vol 55 (5) ◽  
pp. 841-844 ◽  
Author(s):  
Angelo Gandolfi ◽  
Riccardo E. Brizzi ◽  
Filomeno Tedeschi ◽  
Paolo Paini ◽  
Pellegrino Bassi
Keyword(s):  
Differential Diagnosis ◽  
Computerized Tomography ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Frozen Section ◽  
Surgical Removal ◽  
Tumor Type ◽  
Content Type ◽  
Direct Involvement ◽  
Fine Print

✓ Symptomatic subependymomas of the fourth ventricle are rare and usually not included in the preoperative differential diagnosis of tumors in this region. The case of a 63-year-old man with fourth ventricle subependymoma is described. For several years he had suffered with nausea and vomiting, and now presented signs of direct involvement of the posterior fossa. He was investigated preoperatively with computerized tomography, but the ultimate diagnosis was not suspected at that time. The tumor was diagnosed as an subependymoma at operation and was totally excised. This tumor type can easily be recognized on intraoperative frozen section, and its diagnosis should always lead to an attempt at complete surgical removal.

Isolated ventricles following intraventricular hemorrhage

1985 ◽  
Vol 62 (3) ◽  
pp. 357-362 ◽  
Author(s):  
Theodore W. Eller ◽  
Joseph F. Pasternak
Keyword(s):  
Computerized Tomography ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
Clinical Signs ◽  
Premature Neonate ◽  
Content Type ◽  
Isolated Ventricle ◽  
Tomography Scanning ◽  
Fine Print

✓ Panventricular enlargement often follows intraventricular hemorrhage in the premature neonate. During a recent 12-month period, the authors identified five infants who required shunting because of symptomatic post-hemorrhagic hydrocephalus, which was progressive despite serial lumbar punctures and the use of indwelling subcutaneous ventricular reservoirs. In the first 6 months following placement of the initial shunt, four of the infants required an additional shunt for isolated ventricles. Two children had isolation of the lateral ventricles and required bilateral shunts. Two other children had isolation of the fourth ventricle from the lateral ventricular system and required posterior fossa shunts. All of the children were treated successfully using multiple shunts. In all cases, progressive dilation of the isolated ventricle was unaccompanied by the usual clinical signs of shunt malfunction. It appears that isolated ventricular systems are common following post-hemorrhagic hydrocephalus and these children must be followed closely with ultrasound and computerized tomography scanning.

Rapid expansion of a previously asymptomatic subependymoma

2005 ◽  
Vol 103 (6) ◽  
pp. 1084-1087 ◽  
Author(s):  
Adrian W. Laxton ◽  
Patrick Shannon ◽  
Sukriti Nag ◽  
Richard I. Farb ◽  
Mark Bernstein
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Rapid Expansion ◽  
Histopathological Analysis ◽  
Resonance Imaging ◽  
Content Type ◽  
History Of ◽  
Fine Print

✓ This 39-year-old man presented with a 6-month history of occipital headaches. Magnetic resonance imaging revealed an irregularly shaped fourth ventricle mass. One month after his initial presentation, he was admitted to the hospital with significant tumor expansion and clinical deterioration. A posterior fossa craniectomy was performed and the mass was resected. Histopathological analysis of this tumor showed central necrosis with associated edema in an otherwise typical and benign-appearing subependymoma. To the authors' knowledge, this is the first reported case of rapid, nonhemorrhagic expansion associated with necrosis in a previously asymptomatic subependymoma.

Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 533-535 ◽  
Author(s):  
Jin Woo Chang ◽  
Jae Young Choi ◽  
Young Sul Yoon ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Fourth Ventricle ◽  
Gamma Knife Radiosurgery ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Segmental Demyelination ◽  
Content Type ◽  
Clinical Responses ◽  
Fine Print

✓ The purpose of this paper was to present two cases of secondary trigeminal neuralgia (TN) with an unusual origin and lesion location. In two cases TN was caused by lesions along the course of the trigeminal nerve within the pons and adjacent to the fourth ventricle. Both cases presented with typical TN. Brain magnetic resonance imaging revealed linear or wedge-shaped lesions adjacent to the fourth ventricle, extending anterolaterally and lying along the pathway of the intraaxial trigeminal fibers. The involvement of the nucleus of the spinal trigeminal tract and of the principal sensory trigeminal nucleus with segmental demyelination are suggested as possible causes for trigeminal pain in these cases. It is postulated that these lesions are the result of an old viral neuritis. The patients underwent gamma knife radiosurgery and their clinical responses have been encouraging to date.

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