Cases reported "Brain Diseases"

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1/60. Expanding lacunae causing triventricular hydrocephalus. Report of two cases.

    Two patients are reported in whom the presence of triventricular hydrocephalus and aqueductal obstruction or stenosis due to multiple expanding lacunae in the mesencephalothalamic region possibly corresponds to abnormally dilated perivascular spaces. Placement of a ventriculoperitoneal cerebrospinal fluid (CSF) shunt in one patient and the performance of a third ventricle cisternotomy in the other reversed the hydrocephalic syndrome, but did not modify the complex neuroophthalmological disturbance and rubral tremor presumably related to the compressive effects of the lacunae on adjacent parenchyma. In one patient the number and size of the lacunae were increased 4 years after CSF shunt placement. A review of the literature revealed two cases in which magnetic resonance imaging demonstrated a similar, poorly understood pathological condition.
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ranking = 1
keywords = aqueduct
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2/60. Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement. Case report.

    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.
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ranking = 7
keywords = aqueduct
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3/60. Value of constructive interference in steady-state three-dimensional, Fourier transformation magnetic resonance imaging for the neuroendoscopic treatment of hydrocephalus and intracranial cysts.

    OBJECTIVE: To assess the value of constructive interference in steady-state, three-dimensional, Fourier transformation (CISS) magnetic resonance imaging in the endoscopic management of hydrocephalus and intracranial cysts. methods: CISS imaging and T2-weighted imaging were performed for 14 consecutive patients before and after fenestration procedures, using a flexible endoscope, to treat loculated or multiloculated hydrocephalus (4 patients), aqueductal stenosis or obstruction (4 patients), arachnoid cysts (4 patients), a cyst of the velum interpositum (1 patient), or an ependymal cyst (1 patient). Fifteen fenestration procedures were performed, including one reoperation. RESULTS: Preoperative CISS imaging demonstrated intracystic intraventricular septa not observed with conventional T2-weighted imaging for 11 of 15 procedures and provided better brain tissue/cerebrospinal fluid contrast, allowing better understanding of the cause of hydrocephalus and the nature of the cysts. CISS imaging and T2-weighted imaging were equally useful for monitoring postoperative changes in the sizes of ventricles or cysts and the presence of flow voids after third ventriculostomies. However, only CISS imaging clearly demonstrated the site of fenestration for six of the nine patients who underwent fenestration procedures. CONCLUSION: CISS imaging provides excellent cerebrospinal fluid/brain tissue contrast, allowing detailed study of the anatomic features of the ventricular system and cystic lesions. CISS imaging is valuable for both preoperative decision-making and postoperative evaluation.
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ranking = 1
keywords = aqueduct
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4/60. Uncommon third ventricle herniation with cyst formation as a possible result of obstructive hydrocephalus.

    An adult man with an unusual cyst formation, originating from the suprapineal recess is described. The cyst may partly be caused by and may partly have contributed to aqueductstenosis.
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keywords = aqueduct
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5/60. Transaqueductal migration of a neurocysticercus cyst. Case report.

    The clearly documented transaqueductal migration of a solitary intraventricular neurocysticercus cyst is described. The cyst was fortuitously demonstrated on magnetic resonance imaging during migration through the aqueduct. The radiological appearance and clinical significance of this condition are discussed.
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ranking = 6
keywords = aqueduct
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6/60. Neuroendoscopic basket dilation technique for the fenestration of the ventricular wall or intracranial cysts--technical note.

    A basket dilation technique has been developed for fenestration of ventricular or cystic walls, using a basket type widely used in the urological field to collect renal or ureteric stones. This technique allows deep-seated structures to be visualized directly through the expanded basket during dilation and the thinnest part of ventricular wall to easily be pierced, cut, and dilated. Fine control can be exerted over expansion pressure through the hand piece directly connected to the basket tip. In addition, the basket can be rotated to cut the floating tissue that must be removed around the stoma. This basket dilation technique is safer than the balloon inflation technique currently used because it allows visualization of deep-seated structures that cannot be seen through the balloon, and should therefore prove useful in third ventriculostomy, plasty of the sylvian aqueduct, and fenestration of intracranial cystic lesions.
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ranking = 1
keywords = aqueduct
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7/60. Fetal aqueductal glioneuronal hamartoma: a clinicopathological and physiopathological study of three cases.

    Fetal hydrocephalus due to aqueductal stenosis is classified into two main groups: congenital (X-linked, atresia, septa and forking) and acquired (post-infectious or post-hemorrhagic, gliosis and tumors). MATERIAL AND methods: We report three fetal cases presenting with severe hydrocephalus, two of which being apparently sporadic, and the third possibly inherited. On macroscopic examination, no associated malformations were identified, either craniofacial dysmorphy, or visceral abnormalities. Neuropathological study revealed massive hydrocephalus caused by narrowing of the Aqueduct of Sylvius. Histological examination evidenced a nodular, well-demarcated mass producing into the aqueductal lumen, and containing numerous immature proliferating glioneuronal cells. Immunohistochemical analyses did not suggest a developmental abnormality of the subcommissural organ but rather a hamartomatous malformative process. RESULTS: hamartoma of the posterior fossa has been rarely reported. Post-natal cases have been described in the cerebello-pontine angle or in the quadrigeminal plate, and have always been diagnosed as pilocytic or low-grade astrocytomas. In our cases, the lesions could be related to so-called pencil glioma, sometimes associated with type 1 neurofibromatosis and, to our knowledge, have never been described prior to birth. The occurrence during fetal life and the progressive maturation of the nodules are more likely in favor of a hamartomatous process. CONCLUSION: Even though they could sporadically occur, an accurate genetic counseling should be required in order to ensure that there is no familial history of Recklinghausen disease, and to provide a more precise evaluation of recurrence risk.
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ranking = 6
keywords = aqueduct
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8/60. Fiberscopic fenestration and prophylactic stenting of periaqueductal cysts: technical report on three cases.

    The authors report on three consecutive cases of periaqueductal cysts, causing non-communicating hydrocephalus, successfully treated with endoscopic fenestration and aqueductal stenting. Navigation and cyst fenestration were accomplished using a slim (1.1 mm outside diameter) optic fiberscope inserted via a pre-coronal-paramedian burr hole. Third ventriculostomy was also performed after cyst fenestration in two cases. Because of the lack of data regarding such lesions and the possible recurrence with simple fenestration, an aqueductal stent connected to a subcutaneous reservoir was placed, in all 3 cases, under direct visualization. Average duration of the procedure was less than sixty minutes and there were no intra- or perioperative complications. All patients recovered clinically and their postoperative neuroimaging assessment confirmed a decrease in size of both the ventricular system and cyst (mean follow-up: 6.8 months). The authors conclude than this minimally invasive procedure is a promising, safe and effective method to treat cerebral symptomatic periaqueductal cysts and associated non-communicating hydrocephalus.
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ranking = 8
keywords = aqueduct
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9/60. MR imaging of CNS relapse of whipple disease.

    We report a case of late CNS relapse of whipple disease without articular or digestive signs. Magnetic resonance (MR) imaging of the brain clearly showed the disappearance of the normal low intensity signal of the aqueduct of Sylvius and the presence of high intensity signals in the frontal white matter and in the caudate nucleus. This case suggests that MR imaging of the brain is the procedure of choice for identifying cerebral involvement in whipple disease.
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ranking = 1
keywords = aqueduct
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10/60. Symptomatic pineal cyst: case report.

    Pineal cysts are being described with increasing frequency since the advent of magnetic resonance imaging. Although pineal cysts are incidental findings in as many as 4% of magnetic resonance imaging studies, symptomatic pineal cysts are quite rare. We present a case of pineal cyst causing aqueductal obstruction with symptomatic hydrocephalus and resultant headache and syncope, which was treated by surgical resection. A review of the relevant literature and discussion follow.
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ranking = 1
keywords = aqueduct
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