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Carretta A, Zoli M, Martinoni M, Rustici A, Conti A, Mazzatenta D, Palandri G. Isolated entrapment of the lateral ventricle after neuroendoscopic resection of colloid cysts: single - center experience and management. Clin Neurol Neurosurg 2023; 232:107890. [PMID: 37480784 DOI: 10.1016/j.clineuro.2023.107890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND A minimally invasive option of colloid cyst surgical treatment is endoscopic resection, well validated in various reports and clinical practice. A rare complication of the surgical treatment, previously reported only once in literature, is the entrapment of the lateral ventricle. In this study we aim to outline our experience in the management of this occurrence, hypothesizing possible etiopathogenetic causes. METHODS Among patients who underwent neuroendoscopic resection for a colloid cysts at our Institution between 2013 and 2022, cases who developed a postoperative lateral ventricle entrapment were retrospectively reviewed and included. Clinical history, imaging and treatment were reported. RESULTS Among 34 patients treated for a colloid cysts, two (5.9 %) patients developed an ipsilateral ventricular entrapment with dilation from two to five months after the resection. Both patients were substantially asymptomatic and neurologically intact, and therefore treated conservatively. One case underwent complete spontaneous radiological resolution one month later, and the other one has remained neurological asymptomatic at follow-up. CONCLUSIONS Isolated asymptomatic ventricular entrapment with significant dilation after endoscopic colloid cyst resection is a rare occurrence which can be plausibly caused by scar tissue at the level of the foramen of Monro. Because they can have an indolent course with spontaneous resolution, conservative treatment is a viable option, with strict radiological and clinical follow - up. Given the rarity of the occurrence, further studies with larger cohorts are warranted to confirm the etiopathogenetic hypothesis and validate the clinical management.
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Affiliation(s)
- Alessandro Carretta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy.
| | - Matteo Zoli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Arianna Rustici
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
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Aleem Ragab OA, Fathalla H, El Halaby W, Maher W, Hafez M, Zohdi A. Spontaneous Third Ventriculostomy in Cases of Aqueductal Stenosis: A Retrospective Case Series. World Neurosurg 2023; 176:e408-e414. [PMID: 37245667 DOI: 10.1016/j.wneu.2023.05.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Spontaneous third ventriculostomy (STV) is a rare occurrence in cases of obstructive hydrocephalus where the walls of the third ventricle rupture, communicating the ventricular system, and the subarachnoid space leading to arrest of active hydrocephalus. We aim to review our series of STVs while reviewing previous reports. METHODS A retrospective review of cases undergoing cine phase-contrast magnetic resonance imaging (PC-MRI) from 2015 to 2022 of any age with imaging evidence of arrested obstructive hydrocephalus was performed. Patients in which aqueductal stenosis was radiologically evident and the presence of third ventriculostomy through which cerebrospinal fluid flow was detectable were included. Patients who previously underwent endoscopic third ventriculostomy were excluded. Data on patient demographics, presentation, and imaging details of STV and aqueductal stenosis were collected. We searched the PubMed database using the following keyword combination: ((("spontaneous ventriculostomy") OR ("spontaneous third ventriculostomy")) OR ("spontaneous ventriculocisternostomy")) including English reports of STV published between 2010 and 2022. RESULTS Fourteen cases were included (7 adults, 7 pediatrics), all with history of hydrocephalus. STV occurred in the floor of the third ventricle in 57.1% of the cases, at the lamina terminalis in 35.7%, and at both sites in 1 case. Eleven publications reporting 38 cases of STV were identified from 2009 to date. Minimum follow-up period was 10 months and maximum follow-up is 77 months. CONCLUSIONS In cases of chronic obstructive hydrocephalus, neurosurgeons should be minded with the possibility of the presence of an STV on cine phase-contrast magnetic resonance imaging leading to arrested hydrocephalus. The delayed flow at the aqueduct of Sylvius might not be the only determinant of the necessity of cerebrospinal fluid diversion and the presence of an STV should be factored into the neurosurgeon's decision considering the patient's clinical picture.
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Affiliation(s)
| | - Hussein Fathalla
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Walid El Halaby
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Maher
- Department of Radiology, Faculty of Medicine, New Giza University, Cairo, Egypt
| | - Mohamed Hafez
- Department of Radiology, Faculty of Medicine, New Giza University, Cairo, Egypt
| | - Ahmed Zohdi
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Spontaneous third ventriculostomy in patients undergoing fetal surgery for myelomeningocele correction. Childs Nerv Syst 2021; 37:3429-3436. [PMID: 34297200 DOI: 10.1007/s00381-021-05294-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Spontaneous third ventriculostomy (STV) is characterized by the spontaneous rupture of one of the ventricle walls due to increased pressure in the third ventricle caused by obstructive hydrocephalus. Clinically, STV results in resolution of signs and symptoms of intracranial hypertension and head circumference stabilization. No spontaneous STV cases in patients with myelomeningocele have been reported in the literature. The objective of this study was to report three cases of STV in patients with type 2 Chiari malformation who underwent intrauterine treatment. CASE PRESENTATION All patients presented clinically with increased head circumference during outpatient follow-up. Only one patient required a ventriculoperitoneal shunt implantation. The other patients did not require further intervention. CONCLUSION STV is a rare entity that is difficult to diagnose and should always be suspected in spontaneous hydrocephalus resolution, especially in early childhood. STV is not synonymous with hydrocephalus resolution.
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Städt M, Holtmannspötter M, Schwab J, Eff F, Voit-Höhne H. Case report: Flattening of the tectal plate in obstructive hydrocephalus with auto-ventriculostomy. Neuroradiol J 2021; 35:255-259. [PMID: 34340619 DOI: 10.1177/19714009211036686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obstructive hydrocephalus in adulthood can be caused by stenosis in the aqueductal area. Chronic changes lead to a dilatation of the lateral ventricles and ballooning of infratentorial recesses. In rare cases a rupture of the floor of the third ventricle (so-called spontaneous ventriculostomy) has been described in the literature.Case presentation: We present two cases of chronic obstructive hydrocephalus due to aqueductal stenosis in adult patients. Magnetic resonance imaging included phase-contrast-imaging and revealed significant flow through the floor of the third ventricle in keeping with spontaneous ventriculostomy. In addition to other typical changes associated with chronic hydrocephalus, a distinct flattening of the tectal plate could be identified in one case. CONCLUSION We present two cases of spontaneous ventriculostomy in patients with chronic hydrocephalus. To our knowledge, flattening of the tectal plate has not yet been described in the literature and may be caused by continuous cerebrospinal fluid-pulsation.
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Affiliation(s)
- Michael Städt
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
| | - Markus Holtmannspötter
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
| | - Johannes Schwab
- Department of Cardiology, Paracelsus Medical University, General Hospital Nuremberg, Germany
| | - Florian Eff
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
| | - Heinz Voit-Höhne
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
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Tijssen MP, Cornips EMJ, Nicolai J. Teaching Video NeuroImages: Spontaneous Third Ventriculostomy. Neurology 2021; 96:e1266. [PMID: 32907964 DOI: 10.1212/wnl.0000000000010843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Maud P Tijssen
- From the Departments of Radiology (M.P.T.), Neurosurgery (E.M.J.C.), and Neurology (J.N.), Maastricht University Medical Center, the Netherlands
| | - Erwin M J Cornips
- From the Departments of Radiology (M.P.T.), Neurosurgery (E.M.J.C.), and Neurology (J.N.), Maastricht University Medical Center, the Netherlands
| | - Joost Nicolai
- From the Departments of Radiology (M.P.T.), Neurosurgery (E.M.J.C.), and Neurology (J.N.), Maastricht University Medical Center, the Netherlands.
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Spontaneous external rupture of hydrocephalus after fontanelle closure: a case report and review of literature. Childs Nerv Syst 2021; 37:2069-2073. [PMID: 33025149 PMCID: PMC7537948 DOI: 10.1007/s00381-020-04915-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
We report a 2-year-old child with congenital hydrocephalus who presented with a frontal meningocoele due to ventriculo-subgaleal fistula secondary to hydrocephalus (internal rupture), which gradually ruptured spontaneously through the skin. This case is unique given its association with occipital encephalocele and is only the second case to present with external rupture beyond the age of 1 year. Further, the ventricles have ruptured through the skull, after the closure of anterior fontanelle, into the subgaleal space. It challenges the present understanding that external rupture occurs only through an open anterior fontanelle.
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Zuccoli G, Kim A, Poe M, Escolar ML. Spontaneous Third Ventriculostomy in Krabbe Disease. Pediatr Neurol 2020; 108:99-105. [PMID: 32197817 PMCID: PMC7263959 DOI: 10.1016/j.pediatrneurol.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Spontaneous third ventriculostomies have been reported in relation to obstructive hydrocephalus and increased intracranial pressure and are most commonly seen as disruption of the floor of the third ventricle. Hydrocephalus has been reported in patients with Krabbe disease; however, it is clinically difficult to monitor for hydrocephalus in patients with Krabbe disease as symptoms of increased intracranial pressure may overlap with symptoms of Krabbe disease. We describe a case series of spontaneous third ventriculostomy and hydrocephalus, likely in response to increased intracranial pressure, in patients with infantile Krabbe disease. METHODS Brain magnetic resonance images of patients with infantile Krabbe disease were retrospectively analyzed to assess for ventricular size and presence of spontaneous third ventriculostomies. A brain atlas was used to standardize the calculation of ventricular size. Mid-sagittal, T2-weighted images around the third ventricle were assessed for spontaneous third ventriculostomies. Developmental outcomes were measured with a series of standardized and validated tests. RESULTS Seventy-five patients with infantile Krabbe disease were evaluated. Twelve cases of spontaneous third ventriculostomies were identified. Head circumference (SE = 8.07; P < 0.001) and average ventricular volume were greater (left: SE = 1.47, P < 0.001) in patients with spontaneous third ventriculostomies when compared with patients without spontaneous third ventriculostomies. Patients with spontaneous third ventriculostomies also had more delayed development in adaptive (difference = 0.2, P < 0.01), gross motor (difference = 0.0, P < 0.01), and fine motor (difference = 0.1, P < 0.001) function. CONCLUSIONS Spontaneous third ventriculostomies, likely in the context of increased intracranial pressure, were identified in patients with Krabbe disease. Although difficult to assess, our study highlights the importance of monitoring for increased intracranial pressure, which can result in spontaneous third ventriculostomies, in patients with infantile Krabbe disease.
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Affiliation(s)
- Giulio Zuccoli
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aram Kim
- Division of Child Neurology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michele Poe
- Program for the Study of Neurodevelopment in Rare Disorders, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria L Escolar
- Program for the Study of Neurodevelopment in Rare Disorders, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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Timmers AAC, Bos EM, Dammers R. A Case of Spontaneous Third Ventriculocisternostomy to the Interpeduncular Fossa. World Neurosurg 2019; 127:530-533. [PMID: 30851465 DOI: 10.1016/j.wneu.2019.02.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Triventricular hydrocephalus is caused by an obstruction of cerebrospinal fluid flow causing increased intracranial pressure (ICP). Common treatment options include ventricular shunting or endoscopic third ventriculocisternostomy. Spontaneous third ventriculocisternostomy is a rare phenomenon in patients with obstructive triventricular hydrocephalus. We present the case of a patient with triventricular hydrocephalus and evidence of spontaneous third ventriculocisternostomy. CASE DESCRIPTION A 33-year-old female patient was referred to our outpatient clinic for triventricular hydrocephalus diagnosed on imaging. Magnetic resonance imaging (MRI) of her brain showed a triventricular obstructive hydrocephalus owing to a possible aqueductal stenosis. No clinical or diagnostic signs of elevated ICP were present. Repeat imaging showed no changes in cerebral ventricular size and MRI flow imaging demonstrated flow voids in the third ventricle extending through the floor of the third ventricle to the prepontine cistern. We concluded that the cause of hydrocephalus was likely to be a compensated aqueductal stenosis. CONCLUSIONS Spontaneous third ventriculocisternostomy is seen in patients with chronic hydrocephalus. MRI sensitive to flow artefacts can be useful in the diagnosis of patients with apparent compensated hydrocephalus, and phase-contrast imaging can prove cerebrospinal fluid flow across the stoma. Resolution of symptoms owing to elevated ICP is regularly observed in patients with a spontaneous ventriculocisternostomy.
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Affiliation(s)
- Annelieve A C Timmers
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
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Abdulsalam HA, Nissiri F, Das S. Letter: Spontaneous Third Ventriculostomy in a Patient Following Traumatic Brain Injury. Oper Neurosurg (Hagerstown) 2018; 14:E26-E27. [PMID: 29182767 DOI: 10.1093/ons/opx268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hissah Al Abdulsalam
- Division of Neurosurgery St. Michael's Hospital University of Toronto Toronto, Ontario, Canada
| | - Farshad Nissiri
- Division of Neurosurgery St. Michael's Hospital University of Toronto Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery St. Michael's Hospital University of Toronto Toronto, Ontario, Canada.,Keenan Research Centre St. Michael's Hospital Toronto, Ontario, Canada
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Zucchelli M, Galassi E. Higher Failure of Endoscopic Third Ventriculostomy in Infants: The "Distensible" Skull Is the Culprit. Pediatr Neurosurg 2018; 53:163-166. [PMID: 29471295 DOI: 10.1159/000487090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/21/2018] [Indexed: 11/19/2022]
Abstract
The efficacy of endoscopic third ventriculostomy (ETV) in childhood strongly correlates with age. Reasons for the higher failure rate in infants are under debate but the "distensible" head with its immature skull (which would prevent an adequate flow through the ETV and/or a sufficient pressure gradient between the cortical subarachnoid spaces and the venous sinuses) has been suggested as a possible cause. Our evidence of spontaneous conversion of a failed, but always patent, third ventriculostomy into an effective one occurring in a child after maturation of the skull supports this hypothesis.
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