Cases reported "Hydrocephalus"

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1/34. Neuroendoscopic third ventriculostomy in the management of fourth ventricular outlet obstruction.

    Acquired fourth ventricular outlet obstruction, an uncommon entity, has been conventionally managed by ventriculoperitoneal shunt placements or excision of the obstructing membranes. The role of endoscopic third ventriculostomy is highlighted in the present communication. Three patients presenting with symptoms of raised intracranial pressure were diagnosed to have fourth ventricular outlet obstruction by neuroimaging studies and underwent endoscopic third ventriculostomy. All the patients had relief of their symptoms in the postoperative period. neuroimaging studies performed at follow-up revealed decrease in ventricular size in all. Endoscopic third ventriculostomy is a useful alternative in the management of acquired fourth ventricular outlet obstruction.
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2/34. Spontaneous ventriculostomy: report of three cases revealed by flow-sensitive phase-contrast cine MR imaging.

    Spontaneous ventriculostomy is a rare condition that occurs with the spontaneous rupture of a ventricle, resulting in a communication between the ventricular system and the subarachnoid space. Three cases of spontaneous ventriculostomy through the floor of the third ventricle that occurred in cases of chronic obstructive hydrocephalus are presented. The communication was identified via flow-sensitive phase-contrast cine MR imaging. Spontaneous ventriculostomy is probably a result of a rupture of the normally thin membrane that forms the floor of the third ventricle and, with long-standing obstructive hydrocephalus, creates an internal drainage pathway that spontaneously compensates for the hydrocephalus.
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3/34. Blake's pouch cyst: an entity within the Dandy-Walker continuum.

    Abnormal cerebrospinal fluid (CSF) collections within the posterior fossa are defined by the Dandy-Walker complex (DWC) and by arachnoid cysts (AC). The DWC includes the Dandy-Walker malformation (DWM), the Dandy-Walker variant (DWV) and the mega-cisterna magna (MCM). In addition, Tortori-Donati et al. added persistent Blake's pouch cyst (BPC) as an independent entity within the DWC. BPC represents a posterior ballooning of the superior medullary velum into the cisterna magna. All of these malformations are overlapping developmental anomalies characterized by varying degrees of malformation of the medullary vela, the cerebellar vermis and hemispheres, the fourth ventricle choroid plexus, the posterior fossa subarachnoid cisterns and the enveloping meningeal structures. We present two cases of persistent BPC detected in two adult women without history of gestational or subsequent growth problems. They underwent neuroradiological investigation because of headache and because of recurrent episodes of loss of consciousness, respectively. The MRI findings included tetraventricular hydrocephalus, wide communication of the fourth ventricle and the cystic posterior fossa (i.e. BPC), inferior posterior fossa mass effect with or without hypoplasia of both the cerebellar vermis and the medial aspects of the cerebellar hemispheres, and absence of communication between fourth ventricle and the basal subarachnoid space in the midline posteriorly. Persistent BPC is defined by a failure of embryonic assimilation of the area membranacea anterior within the tela choroidea associated with imperforation of the foramen of Magendie. Typically this condition becomes symptomatic early in life. In the current cases the normal function of the laterally positioned foramina of Luschka probably helped to maintain some CSF flow between intraventricular and subarachnoid spaces, with the establishment of a precarious equilibrium characterized by a compensatory enlargement of the cerebral ventricular system (i.e. hydrocephalus).
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4/34. Brief communication: An early case of hydrocephalus: the Middle Paleolithic Qafzeh 12 child (israel).

    Remains of 15 hominids were recovered within a Mousterian archaeological context in the cave of Qafzeh, israel. Dated to ca. 95 kyr BP, this skeletal material has been crucial for understanding biological, chronological, and cultural aspects of anatomically modern ancient Homo sapiens. The high proportion of children (N = 8) in Qafzeh Cave is unique among Middle Palaeolithic sites and encourages the search for skeletal evidence of disease and trauma. We report on the case of one child, Qafzeh 12, ca. 3 years old (according to modern human reference standards), who manifests some outstanding skeletal abnormalities that indicate hydrocephalus.
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5/34. Expansion of central arachnoid pouches.

    Three case of central arachnoid pouches or cysts which are freely in communication with the subarachnoid space and cause hydrocephalus are reported. One case died; the second recovered following transtentorial opening of a huge cystic cavity located between the tentorium and the cerebellum, which opened into the cisterna magna. The patient was well although mentally retarded 6 years later. The third case was treated with a ventriculoatrial shunt and has fully recovered. In these cases, the shape and situation of the pouches are consistent with a processes of upward movement of CSF. In the CSF waves, originating from constant variations of venous pressure, there is an obvious aetiological factor. Even if the hydrocephalus were primary and the pouch secondary, the pouch might contribute to the progression of the former by occasional compression of the aqueduct. This can be another example of the way hydrocephalus leads to its own exacerbation.
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6/34. Intraoperative direct neuroendoscopic observation of the aqueduct in Dandy-Walker malformation.

    A 3-month-old female infant with Dandy-Walker malformation manifesting as hydrocephalus was treated successfully by only ventriculoperitoneal shunting. A flexible neuroendoscope was used intraoperatively to confirm the patency of the aqueduct, i.e. communication of the ventricular system and the cyst in the posterior fossa. Direct confirmation of the patency of the aqueduct and cyst communication is valuable to select the shunt procedure in the treatment of Dandy-Walker malformation.
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7/34. syringomyelia associated with hydrocephalus and Blake's pouch cyst: case report.

    STUDY DESIGN: This is a case report of a 37-year-old woman who sought treatment for a large syringomyelic cavitation extending from C3 to the entire medulla, a tetraventricular hydrocephalus, and a cystic cavitation in the posterior cranial fossa communicating with the fourth ventricle (Blake's pouch cyst). The patient underwent a decompressive craniectomy, a C1 laminectomy, and the opening of the cysts to enable communication with the subarachnoid spaces. After an initial period of symptom remission, reassured by the magnetic resonance images indicating a reduction of the syringomyelia, the patient's neurologic conditions deteriorated because of further dilation of the ventricular cavities, which was resolved by the insertion of a ventriculoperitoneal shunt. OBJECTIVE: To suggest the treatment of choice in a patient with syringomyelia and hydrocephalus caused by Blake's pouch cyst. SUMMARY OF BACKGROUND DATA: Blake's pouch cyst is an entity often poorly understood, deriving from nonperforation of the primitive foramen of Magendie, causing a precarious equilibrium of the cerebrospinal fluid flow resulting from a defect in communication between the fourth ventricle and the encephalic and spinal subarachnoid spaces. Authors report the association of Blake's pouch cyst with cervicodorsal syringomyelia and tetraventricular hydrocephalus. methods: A case of syringomyelia associated with hydrocephalus and Blake's pouch cyst is described. RESULTS: Symptoms of syringomyelia and hydrocephalus disappeared only after positioning of a ventriculoperitoneal shunt. CONCLUSIONS: The treatment of choice for a case of syringomyelia associated with Blake's pouch cyst and hydrocephalus is the application of a ventriculoperitoneal shunt or, even better, an endoscopic third ventriculostomy.
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8/34. Neuroendoscopic septostomy for isolated lateral ventricle.

    The clinical features and endoscopic findings were investigated in 20 patients with isolated lateral ventricle treated by neuroendoscopic septostomy to establish cerebrospinal fluid communication and open an isolated ventricular compartment. The endoscopic procedure was incomplete because of thickened septum pellucidum and insufficient working space in two adults with postmeningitic hydrocephalus. Two children underwent second septostomy. In all other cases, results were good and there were no complications related to endoscopic procedures. Endoscopic septostomy is less invasive and has few complications. Intraoperative navigation and the biportal approach may be required in difficult cases with multiple septum formation and severe postmeningitic hydrocephalus. Adequate stomal size is required in high-risk groups including children under 2 years of age.
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9/34. Radionuclide cisternography in diagnostics of obstruction hydrocephalus in introduced ventriculoperitoneal shunt.

    BACKGROUND: To confirm or exclude a diagnosis of internal obstruction hydrocephalus in an 8-year old girl with an introduced ventriculoperitoneal (V-P) shunt. CASE REPORT: Establishing the V-P shunt is indisputably the route of choice in non-communicating hydrocephalus. The existence of a V-P shunt, however, is connected with numerous risks, especially of injuries, infection as well as increased intraabdominal pressure--e.g. in pregnancy. The development of endoscopy in neurosurgery allows the creation of communication via the bottom of the third ventricle with basal cisterns, and the subsequent cancellation of a V-P shunt. MATERIAL AND methods: We describe the case of an 8-year old girl with congenital internal hydrocephalus with an assumed obliteration of the Sylvian aqueduct with an established V-P shunt. An MR scan described the membrane in the area of the Sylvian aqueduct, but the disproportion between the dilatation of the lateral ventricles, third ventricle and fourth ventricle led the physician to doubt as to the accuracy of the diagnosis of internal obstruction hydrocephalus. Therefore we performed a radionuclide cisternography (in a modified manner), which proved an existing communication between the third and fourth cerebral ventricle and which contradicted the clinical diagnosis of obstruction hydrocephalus.
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keywords = communication
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10/34. Ventilatory impairment during laparoscopic cholecystectomy in a patient with a ventriculoperitoneal shunt.

    A patient with a recently placed ventriculoperitoneal shunt suffered ventilatory impairment due to decreased thoracic compliance related to massive subcutaneous emphysema during laparoscopic cholecystectomy. The patient recovered uneventfully; however, recently established closed communication between the peritoneal cavity and the subcutaneous space may be a relative contraindication to laparoscopic surgery.
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