Isolated fourth ventricle as a complication of ventricular shunting

1978 ◽  
Vol 49 (6) ◽  
pp. 910-913 ◽  
Author(s):  
John C. Hawkins ◽  
Harold J. Hoffman ◽  
Robin P. Humphreys
Keyword(s):  
Computerized Tomography ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Normal Function ◽  
Shunt Malfunction ◽  
Cerebellar Dysfunction ◽  
Content Type ◽  
Isolated Fourth Ventricle ◽  
Ventricular Shunting ◽  
Fine Print

✓ Signs of cerebellar dysfunction combined with signs suggestive of shunt malfunction developed in three children with obstructive hydrocephalus. Shunt function was normal. In all cases, the cerebellar signs persisted and computerized tomography scans revealed enlargement of the fourth ventricle. Shunting of the fourth ventricle returned the patients to normal function.

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.

Obstructive hydrocephalus caused by an abnormal vein in the aqueduct

1991 ◽  
Vol 75 (6) ◽  
pp. 960-962 ◽  
Author(s):  
Akira Watanabe ◽  
Ryoji Ishii ◽  
Masaki Kamada ◽  
Yasuo Suzuki ◽  
Kazuhiro Hirano ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Ventriculoperitoneal Shunt ◽  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Resonance Imaging ◽  
Content Type ◽  
Fine Print

✓ A case is reported of aqueductal stenosis caused by an abnormal draining vein and demonstrated by computerized tomography and magnetic resonance imaging. Placement of a ventriculoperitoneal shunt relieved the patient's progressive headaches.

Nonsurgical resolution of a brain-stem abscess

1980 ◽  
Vol 53 (5) ◽  
pp. 726-727 ◽  
Author(s):  
Jesús Vaquero ◽  
José M. Cabezudo ◽  
Guillermo Leunda
Keyword(s):  
Brain Stem ◽  
Computerized Tomography ◽  
Obstructive Hydrocephalus ◽  
Surgical Drainage ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Weber Syndrome ◽  
Clinical Pictures ◽  
Fine Print

✓ A case of solitary mesencephalic abscess in a 13-year-old boy is presented. The computerized tomography and clinical pictures, indicating a Weber syndrome and obstructive hydrocephalus, resolved totally 20 days after implantation of a ventriculoatrial shunt and treatment with intravenous chloramphenicol and penicillin. This is the fifth reported case of survival in a patient with a brain-stem abscess, and the first in which this outcome has been achieved without surgical drainage of the abscess.

Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction

1999 ◽  
Vol 90 (2) ◽  
pp. 227-236 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Christian Sainte-Rose ◽  
Isabelle Simon ◽  
Guillaume Lot ◽  
Spiros Sgouros
Keyword(s):  
Pressure Gradient ◽  
Obstructive Hydrocephalus ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Upward Gaze Palsy ◽  
Ocular Signs ◽  
Gaze Palsy ◽  
Fine Print

Object. This study is a retrospective analysis of clinical data obtained in 28 patients affected by obstructive hydrocephalus who presented with signs of midbrain dysfunction during episodes of shunt malfunction.Methods. All patients presented with an upward gaze palsy, sometimes associated with other signs of oculomotor dysfunction. In seven cases the ocular signs remained isolated and resolved rapidly after shunt revision. In 21 cases the ocular signs were variably associated with other clinical manifestations such as pyramidal and extrapyramidal deficits, memory disturbances, mutism, or alterations in consciousness. Resolution of these symptoms after shunt revision was usually slow. In four cases a transient paradoxical aggravation was observed at the time of shunt revision. In 11 cases ventriculocisternostomy allowed resolution of the symptoms and withdrawal of the shunt.Simultaneous supratentorial and infratentorial intracranial pressure recordings performed in seven of the patients showed a pressure gradient between the supratentorial and infratentorial compartments, with a higher supratentorial pressure before shunt revision. Inversion of this pressure gradient was observed after shunt revision and resolution of the gradient was observed in one case after third ventriculostomy. In six recent cases, a focal midbrain hyperintensity was evidenced on T2-weighted magnetic resonance imaging sequences at the time of shunt malfunction. This rapidly resolved after the patient underwent third ventriculostomy.Conclusions. It is probable that in obstructive hydrocephalus, at the time of shunt malfunction, the development of a transtentorial pressure gradient could initially induce a functional impairment of the upper midbrain, inducing upward gaze palsy. The persistence of the gradient could lead to a global dysfunction of the upper midbrain. Third ventriculostomy contributes to equalization of cerebrospinal fluid pressure across the tentorium by restoring free communication between the infratentorial and supratentorial compartments, resulting in resolution of the patient's clinical symptoms.

Diffuse craniospinal seeding from a benign fourth ventricle choroid plexus papilloma

1998 ◽  
Vol 88 (4) ◽  
pp. 757-760 ◽  
Author(s):  
Richard Leblanc ◽  
Sabah Bekhor ◽  
Denis Melanson ◽  
Stirling Carpenter
Keyword(s):  
Choroid Plexus ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Choroid Plexus Papilloma ◽  
Blurred Vision ◽  
Content Type ◽  
Biological Potential ◽  
History Of ◽  
Fine Print ◽  
Plexus Papilloma

✓ Choroid plexus papillomas can metastasize to the subarachnoid space, but extensive metastasis has only been reported when the tumors are malignant. The authors report a case of diffuse, extensive metastasis to the craniospinal leptomeninges from a benign fourth ventricular choroid plexus papilloma in an adult. This 19-year-old woman presented with a 2-year history of headache, blurred vision, diplopia, and ataxia. Magnetic resonance imaging of the brain and spinal cord revealed obstructive hydrocephalus caused by a 4-cm, partially calcified, inhomogeneously enhancing tumor of the fourth ventricle that was displacing the pons, medulla oblongata, and cerebellum. Innumerable cystic lesions of varying size were also seen in the cranial and spinal leptomeninges. Histological examination of the resected fourth ventricular tumor and of a few of the leptomeningeal lesions revealed a benign choroid plexus papilloma and leptomeningeal choroid plexus cysts. This singular case of diffuse and extensive metastasis to the craniospinal leptomeninges from a histologically benign fourth ventricular papilloma adds to the available information about the biological potential of these tumors and expands the differential diagnosis of posterior fossa lesions with subarachnoid metastasis.

Detection of cryptic vascular malformations by computerized tomography

1979 ◽  
Vol 51 (4) ◽  
pp. 546-551 ◽  
Author(s):  
Hideo Terao ◽  
Tomokatsu Hori ◽  
Masao Matsutani ◽  
Riki Okeda
Keyword(s):  
Arteriovenous Malformation ◽  
Computerized Tomography ◽  
Fourth Ventricle ◽  
Vascular Malformations ◽  
Cavernous Angioma ◽  
The Other ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Subarachnoid Hemorrhages ◽  
Fine Print

✓ Two cases of cryptic vascular malformation that were not demonstrated by cerebral angiography were detected by computerized tomography. One of these patients had a cavernous angioma in the fourth ventricle with recurrent subarachnoid hemorrhages, and the other harbored a small arteriovenous malformation and intracerebral hematoma. The usefulness and limitations of computerized tomography in the identification of cryptic vascular malformations are discussed.

Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation Type I decompression

2005 ◽  
Vol 103 (4) ◽  
pp. 752-755 ◽  
Author(s):  
Laurence A. G. Marshman ◽  
Jonathan C. Benjamin ◽  
Sanjiv J. Chawda ◽  
Karoly M. David
Keyword(s):  
Mr Imaging ◽  
Chiari Malformation ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Shunt Insertion ◽  
Content Type ◽  
Fine Print

✓ Obstructive hydrocephalus complicating foramen magnum decompression (FMD) for a Chiari malformation (CM) Type I is rare. Two female patients (17 and 55 years old) presented with strain-related headaches. In both cases magnetic resonance (MR) imaging studies confirmed a CM Type I, which was accompanied by syringomyelia in one case. Both patients underwent uncomplicated FMD with good initial recovery. Unfortunately, conditions in both patients deteriorated, with severe headaches occurring between Days 5 and 6 post-FMD. Decreased consciousness occurred in one case. In both patients, computerized tomography scanning demonstrated an acute obstructive hydrocephalus associated with bilateral infratentorial extraaxial fluid collections (EAFCs). In addition, left parafalcine and convexity EAFCs were present in one case. An emergency external ventricular drain was required in one patient, with delayed conversion to a ventriculoperitoneal shunt. Spontaneous resolution occurred in the other patient without neurosurgical intervention. In both cases, MR imaging confirmed that each EAFC was subdural, resembled cerebrospinal fluid (CSF), and had distorted the superior cerebellum anteroinferiorly. Despite upper fourth ventricle/aqueduct compromise in one case, normal aqueduct flow artifacts were apparent on examination. All EAFCs resolved spontaneously. Obstructive hydrocephalus complicating FMD is rare but invariably associated with infratentorial EAFCs, which were confirmed to be subdural hygromas in this report. The authors assert that hydrocephalus results from upper fourth ventricle/aqueduct compromise as a result of CSF subdural dissection following a pinhole arachnoid tear on durotomy. Because such hygromas spontaneously resolve, permanent shunt insertion should be avoided.

Effects of ventriculoperitoneal shunt removal on cerebral oxygenation and brain compliance in chronic obstructive hydrocephalus

2001 ◽  
Vol 94 (4) ◽  
pp. 573-581 ◽  
Author(s):  
Toru Fukuhara ◽  
Mark G. Luciano ◽  
Christine L. Brant ◽  
Jennifer Klauscie
Keyword(s):  
Cerebral Oxygenation ◽  
Obstructive Hydrocephalus ◽  
Canine Model ◽  
Shunt Malfunction ◽  
Control Group ◽  
Chronic Obstructive ◽  
Content Type ◽  
Shunt Placement ◽  
Shunt Removal ◽  
Fine Print

Object. The pathophysiology of shunt malfunction has not been fully examined, probably because of the paucity of appropriate animal models. Using a canine model of chronic obstructive hydrocephalus, the effects of shunt placement and removal on physiological parameters were evaluated. Methods. Fifteen dogs, nine in which chronic hydrocephalus was induced and six controls, were used in the experiment. Thirteen weeks after the induction of hydrocephalus, intracranial pressure (ICP), tissue and cerebrospinal fluid O2 saturation, response to hyperventilation, and brain compliance at low (5–15 mm Hg) and high (15–25 mm Hg) pressures were measured (untreated stage). Following this procedure, ventriculoperitoneal shunts were implanted in the dogs suffering from hydrocephalus. Two weeks later, the same series of measurements were repeated (shunted stage), following which the shunt systems were removed. One week after shunt removal, the last measurements were obtained (shunt-removed stage). All dogs underwent magnetic resonance imaging four times: before induction of hydrocephalus and before each measurement. All dogs with hydrocephalus also had ventriculomegaly (1.42 ± 0.89 ml before induction of hydrocephalus compared with 3.4 ± 1.64 ml 13 weeks after induction, p = 0.0064). In dogs in the untreated hydrocephalus stage, ICP remained within the normal range (8.33 ± 2.60 mm Hg)—although it was significantly higher than that in the control group (5 ± 1.41 mm Hg, p = 0.014). Tissue O2 saturation in the dogs in the hydrocephalus group (26.1 ± 5.33 mm Hg) was lower than that in the dogs in the control group (48.7 ± 4.27 mm Hg, p < 0.0001). After the dogs underwent shunt placement, significant improvement was observed in their ICP (5.22 ± 2.17 mm Hg, p = 0.012) and tissue O2 saturation (35.2 ± 6.80 mm Hg, p = 0.0084). However, removal of the shunt reversed these improvements back to the preshunt status. Hyperventilation induced significant decreases in ICP and O2 saturation at every measurement time and induced a significant decrease in tissue O2 saturation during the shunted stage, but not during the untreated and shunt-removed stages. Brain compliance measured at high pressure demonstrated a significant gradual decrease at every measurement. Conclusions. In chronic obstructive hydrocephalus, shunt placement improves ICP and cerebral oxygenation as well as the response to hyperventilation in the tissue. Shunt removal reverses these improvements back to levels present during the untreated stage. The decrease in brain compliance may be one of the factors responsible for symptoms in shunt malfunction.

Double-contrast ventriculography with oxygen and water-soluble positive contrast medium, metrizamide (Amipaque)

1979 ◽  
Vol 51 (2) ◽  
pp. 211-218 ◽  
Author(s):  
Antti Servo ◽  
Viljo Halonen
Keyword(s):  
Contrast Medium ◽  
Computerized Tomography ◽  
Obstructive Hydrocephalus ◽  
Positive Contrast ◽  
Ct Scanning ◽  
Water Soluble ◽  
Double Contrast ◽  
Content Type ◽  
Contrast Ventriculography ◽  
Fine Print

✓ A technique for ventriculography using both gas and a positive contrast medium metrizamide (Amipaque) is presented. This ventriculographic method proved superior to computerized tomography (CT) scanning in revealing the cause of obstructive hydrocephalus. Small central tumors and intraventricular cysts, often missed with CT, were also well demonstrated. This technique has been used since 1975, and is simple an$ safe.

Spontaneous lateral ventriculocisternostomy documented by metrizamide CT ventriculography

1981 ◽  
Vol 54 (1) ◽  
pp. 101-104 ◽  
Author(s):  
Ashwani Kapila ◽  
Thomas P. Naidich
Keyword(s):  
Computerized Tomography ◽  
Subarachnoid Space ◽  
Obstructive Hydrocephalus ◽  
Contrast Material ◽  
Content Type ◽  
Choroid Fissure ◽  
Fine Print

✓ In a patient with partially shunted obstructive hydrocephalus from a third ventricular astrocytoma, metrizamide ventriculography combined with computerized tomography demonstrated spontaneous ventriculocisternostomy with passage of contrast material from the atrium into the choroid fissure and posterior subarachnoid space.

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