scholarly journals Combined approach of multiloculated hydrocephalus and isolated fourth ventricle

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e292020
Author(s):  
Lucas de Souza Rodrigues dos Santos ◽  
Leo Gordiano Matias ◽  
Fernando Luís Maeda ◽  
Humberto Belem De Aquino ◽  
Enrico Ghizoni
Keyword(s):  
Fourth Ventricle ◽  
Late Onset ◽  
External Ventricular Drain ◽  
Ventricular Catheter ◽  
Skin Closure ◽  
Combined Approach ◽  
Left Lateral Ventricle ◽  
Multiloculated Hydrocephalus ◽  
Isolated Fourth Ventricle ◽  
Myelomeningocele Repair

A female newborn patient presents with meningitis and hydrocephalus after lumbosacral myelomeningocele repair and skin closure. An external ventricular drain was used during the meningitis treatment. Patient had a late onset multiloculated hydrocephalus and isolated fourth ventricle on CT scan follow-up. We performed combined approach with a craniotomy, dissection of intraparietal sulcus entering in the atrium of left lateral ventricle and used endoscopic assistance to fenestrate intraventricular septations and to put a ventricular catheter through tentorium to drain both supra and infratentorial ventricles. The patient improved clinically and radiologically.

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.

Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement

2000 ◽  
Vol 92 (6) ◽  
pp. 1036-1039 ◽  
Author(s):  
Masahiro Shin ◽  
Akio Morita ◽  
Shuichiro Asano ◽  
Keisuke Ueki ◽  
Takaaki Kirino
Keyword(s):  
Stent Placement ◽  
Surgical Procedure ◽  
Fourth Ventricle ◽  
Rare Complication ◽  
Ventricular Catheter ◽  
Foramen Of Monro ◽  
Content Type ◽  
Shunt Placement ◽  
Progressive Cerebellar Ataxia ◽  
Isolated Fourth Ventricle

✓ Isolated fourth ventricle (IFV) is a rare complication in patients who undergo shunt placement, and it is not easily corrected by surgical procedures. The authors report a case of IFV that was successfully treated with an aqueductal stent placed under direct visualization by using a neuroendoscope. This 36-year-old suffered meningitis after partial resection of a brainstem pilocytic astrocytoma, and subsequently developed hydrocephalus for which a ventriculoperitoneal shunt was placed. Nine months later, the patient presented with progressive cerebellar ataxia, and magnetic resonance imaging revealed slitlike supratentorial ventricles and a markedly enlarged fourth ventricle, which were compatible with the diagnosis of IFV. The surgical procedure described was performed under visualization through a styletlike slim optic fiberscope inserted into a ventricular catheter. The catheter, with the endoscope inside it, was passed through the foramen of Monro and then through the aqueduct to reach the enlarged fourth ventricle, where membranous occlusion of the foramen of Magendie was clearly visualized. The tip of the catheter was placed in the fastigium of the fourth ventricle. After the procedure, the size of the fourth ventricle was reduced and the patient's symptoms improved. Thus, it is concluded that endoscopic aqueductal stent placement is a simple and safe surgical procedure for treatment of IFV.

scholarly journals Role of intraoperative computed tomography scanner in modern neurosurgery – An early experience

2020 ◽  
Vol 11 ◽  
pp. 247
Author(s):  
Mohammad Ashraf ◽  
Nabeel Choudhary ◽  
Syed Shahzad Hussain ◽  
Usman Ahmad Kamboh ◽  
Naveed Ashraf
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
External Ventricular Drain ◽  
Colloid Cyst ◽  
Ventricular Catheter ◽  
Low Grade ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Multiloculated Hydrocephalus ◽  
Wide Range

Background: Intraoperative imaging addresses the limitations of frameless neuronavigation systems by providing real-time image updates. With the advent of new multidetector intraoperative computed tomography (CT), soft tissue can be visualized far better than before. We report the early departmental experience of our intraoperative CT scanner’s use in a wide range of technically challenging neurosurgical cases. Methods: We retrospectively analyzed the data of all patients in whom intraoperative CT scanner was utilized. Out of 31 patients, 24 (77.4%) were cranial and 8 (22.6%) spinal cases. There were 13 male (41.9%) and 18 (58.1%) female patients, age ranged from 1 to 83 years with a mean age of 34.29 years ±17.54 years. Seven patients underwent spinal surgery, 2 cases were of orbital tumors, and 16 intra-axial brain tumors, including 5 low- grade gliomas, 10 high-grade gliomas, and 1 colloid cyst. There were four sellar lesions and two multiloculated hydrocephalus. Results: The intraoperative CT scan guided us to correct screw placement and was crucial in managing four complex spinal instabilities. In intracranial lesions, 59% of cases were benefitted due to intraoperative CT scan. It helped in the precise placement of ventricular catheter in multiloculated hydrocephalus and external ventricular drain for a third ventricular colloid cyst. Conclusion: Intraoperative CT scan is safe and logistically and financially advantageous. It provides versatile benefits allowing for safe and maximal surgery, requiring minimum changes to an existing neurosurgical setup. Intraoperative CT scan provides clinical benefit in technically difficult cases and has a smooth workflow.

The marionette technique for treatment of isolated fourth ventricle

2013 ◽  
Vol 12 (4) ◽  
pp. 339-343 ◽  
Author(s):  
Pierluigi Longatti ◽  
Elisabetta Marton ◽  
Salima Magrini
Keyword(s):  
Surgical Treatment ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Operating Rooms ◽  
Simple Method ◽  
Less Invasive ◽  
Isolated Fourth Ventricle ◽  
Ventricular Catheters ◽  
Endoscopic Aqueductoplasty

Isolated fourth ventricle is not uncommon in complex posthemorrhagic or postinfectious hydrocephalus. When the condition is symptomatic, the current surgical treatment is endoscopic aqueductoplasty, followed by endoscope-assisted placement of a catheter in the fourth ventricle. The authors suggest a very simple method of steering the tip of standard ventricular catheters by using materials commonly available in all operating rooms. The main advantage of this method is that it permits less invasive transaqueductal drainage of trapped fourth ventricles, especially in cases of narrow third ventricle, because the scope and catheter are introduced in sequence and not in a double-barreled fashion. Two illustrative cases are reported.

Giant syringobulbia associated with cerebellopontine angle arachnoid cyst and hydrocephalus

2011 ◽  
Vol 8 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Ai Muroi ◽  
Nigel Peter Syms ◽  
Shizuo Oi
Keyword(s):  
Arachnoid Cyst ◽  
Head Circumference ◽  
Lateral Ventricle ◽  
Cerebellopontine Angle ◽  
External Ventricular Drainage ◽  
Magnetic Resonance Images ◽  
Ventricular Catheter ◽  
Cerebrospinal Fluid Diversion ◽  
Left Lateral Ventricle ◽  
The Brain

The aim in reporting this case was to discuss the pathophysiology and treatment issues in an infant with a giant syringobulbia associated with a right cerebellopontine angle (CPA) arachnoid cyst causing noncommunicating hydrocephalus. This 7-month-old infant presented to the hospital with a history of delayed milestones and an abnormal increase in head circumference. Magnetic resonance images and CT scans of the brain showed a large CSF cavity involving the entire brainstem and a right CPA arachnoid cyst causing obstruction of the fourth ventricle and dilation of the lateral and third ventricles. Cerebrospinal fluid diversion was performed by direct communication from the syringobulbia cavity to the left lateral ventricle and from the left lateral ventricle through another ventricular catheter; external ventricular drainage was performed temporarily for 5 days. Communication between the syrinx and arachnoid cyst was confirmed. Clinically, there was a reduction in head circumference, and serial MR imaging of the brain showed a decrease in the size of the syrinx cavity and the ventricle along with opening of the normal CSF pathways. The postoperative course was uneventful, and no further intervention was necessary. On follow-up of the child at 3 years, his developmental milestones were normal. Surgical intervention for this condition is mandatory. The appropriate type of surgery should be performed on the basis of the pathophysiology of the developing syringobulbia.

scholarly journals Bilateral transtentorial herniation and isolated fourth ventricle: A scientific note

2010 ◽  
Vol 58 (6) ◽  
pp. 953 ◽  
Author(s):  
Laszlo Novak ◽  
Istvan Pataki ◽  
Andrea Nagy ◽  
Ervin Berenyi
Keyword(s):  
Fourth Ventricle ◽  
Transtentorial Herniation ◽  
Scientific Note ◽  
Isolated Fourth Ventricle

scholarly journals A Feline Case of Isolated Fourth Ventricle with Syringomyelia Suspected to be Related with Feline Infectious Peritonitis

2007 ◽  
Vol 69 (7) ◽  
pp. 759-762 ◽  
Author(s):  
Masato KITAGAWA ◽  
Midori OKADA ◽  
Tsuneo SATO ◽  
Kiichi KANAYAMA ◽  
Takeo SAKAI
Keyword(s):  
Fourth Ventricle ◽  
Feline Infectious Peritonitis ◽  
Isolated Fourth Ventricle

scholarly journals Isolated fourth ventricle haemorrhage: “think beyond intracranial source’’ unusual presentation of lumbosacral spine arteriovenous malformation presentation

2019 ◽  
pp. 59-62
Author(s):  
Naresh Panwar ◽  
Manish Agrawal ◽  
Ghanshyam Agrawal ◽  
V. D. Sinha
Keyword(s):  
Arteriovenous Malformation ◽  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
Spinal Column ◽  
Sudden Onset ◽  
Severe Headache ◽  
Vascular Lesions ◽  
Lumbosacral Spine ◽  
Isolated Fourth Ventricle ◽  
Spinal Arteriovenous Malformations

Spinal arteriovenous malformations (SAVMs) are rare vascular lesions and account for about 4% of primary intraspinal masses. Since SAVMs can involve any location along the spinal column and produce a host of different problems, the symptoms are extremely variable. There are few reports of simultaneous cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM (SAVMs). Herein, we present a rare case of Lumbo Sacral spine arteriovenous malformation, which clinically manifests as sudden onset of severe headache and vomiting due to isolated fourth ventricle Hemorrhage (IVH) without cerebral subarachnoid hemorrhage.

Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 100-106 ◽  
Author(s):  
David I. Sandberg ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Pediatric Patients ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Neurological Outcomes ◽  
Multiloculated Hydrocephalus ◽  
Before And After ◽  
Posterior Parietal ◽  
Ventricular Catheters

Abstract OBJECTIVE: To assess the treatment of progressive multiloculated hydrocephalus by craniotomy for microsurgical fenestration of cerebrospinal fluid (CSF) compartments to minimize the number of ventricular catheters. METHODS: We studied 33 pediatric patients who underwent craniotomies for fenestration of progressive multiloculated hydrocephalus between 1989 and 2003. In 20 of 33 patients, hydrocephalus was attributed to intraventricular hemorrhage associated with prematurity. Twenty-three of 33 patients had previous central nervous system infections. Craniotomy was typically performed via a posterior parietal approach. Communication between bilateral supratentorial loculated compartments and posterior fossa compartments was achieved. Surgical and neurological outcomes were assessed. RESULTS: Fenestration of loculated CSF spaces was performed successfully in all patients. No new neurological deficits were noted after surgery, and no patients required intraoperative blood transfusions. CSF infections within 3 months after surgery occurred in 4 of 33 patients. Over a median follow-up period of 3.7 years (range, 1.5 mo to 8.7 yr), 19 of 33 patients required additional fenestration procedures. The number of repeat fenestration procedures ranged from one to six, and a total of 47 additional fenestrations were performed in these 19 patients. The majority of patients (n = 25) ultimately required shunt systems with only one ventricular catheter. The neurological status of these patients was extremely poor both before and after surgery. Twenty-nine of 33 patients were severely delayed, and four were mildly delayed. CONCLUSION: Fenestration of multiloculated CSF compartments can enable most patients to function with a single ventricular catheter shunt system. Neurological status remains poor in this patient population.

Isolated Fourth Ventricle

1989 ◽  
pp. 110-111
Author(s):  
Shizuo Oi ◽  
Satoshi Matsumoto
Keyword(s):  
Fourth Ventricle ◽  
Isolated Fourth Ventricle
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