1/201. choroid plexus papilloma. I. Proof of cerebrospinal fluid overproduction.Utilizing a ventricular perfusion technique, the rate of CSF formation was determined in a 2-year-old child before and after removal of a 74 g choroid plexus papilloma from the left lateral ventricle. Preoperatively, the CSF formation rate was 1.05 /- SD 0.01 ml/min (1,656 ml/day). Postoperatively, the CSF formation rate was reduced fivefold to 0.20 /- SD 0.01 ml/min (288 ml/day). Whereas these data are regarded as conclusive evidence of CSF overproduction by a choroid plexus papilloma, the pathogenesis of generalized ventricular enlargement in this case was due to part to obstruction of the subarachnoid pathways.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/201. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage.This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricular haemorrhage and a small round low-dense lesion within the haematoma at the right trigone. The haematoma with obstructive hydrocephalus made the lateral ventricles larger on the right than on the left. CT scan could not detect any subarachnoid haemorrhage. Right interal carotid angiography revealed a saccular aneurysm at the plexal point of the right anterior choroidal artery. We approached the aneurysm and the small round lesion through the trigone via a right temporo-occipital corticotomy. We could clip the aneurysmal neck and remove the intraventricular haematoma and the papillary cystic mass (corresponding to the small round lesion on CT scan) totally in one sitting. Histological examination revealed the aneurysm to be a true one and the papillary cystic mass to be a choroid plexus cyst.- - - - - - - - - - ranking = 0.16666666666667keywords = plexus (Clic here for more details about this article) |
3/201. Central neurocytoma of the fourth ventricle. Case report.The authors report on a 17-year-old boy who suffered from slowly progressive and long-standing symptoms of ataxia, neck pain, and headache. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed a tumor arising from the floor of the fourth ventricle that resulted in a moderate hydrocephalus. A partial resection was performed. Histological and immunohistological findings led to the diagnosis of an atypical central neurocytoma of the fourth ventricle. The imaging features on CT scanning, MR imaging, and proton MR spectroscopy studies, the clinical picture, and the prognosis of this very unusual tumor are discussed. Three cases of neurocytomas in the posterior fossa have been described to date; however, in all three cases some atypical aspects were present. In the present case, with the exception of the very unusual location, both imaging findings and clinical history perfectly met the definition of this rare tumor.- - - - - - - - - - ranking = 6.0159576945366E-5keywords = pain (Clic here for more details about this article) |
4/201. dandy-walker syndrome successfully treated with cystoperitoneal shunting--case report.A neonate presented with dandy-walker syndrome manifesting as a large posterior cranial fossa cyst, aplasia of the lower cerebellar vermis, and elevation of the confluence of the sinuses but without hydrocephalus. A cystoperitoneal shunt was placed at one month after birth. The cyst diminished in size, and marked development of the cerebellar hemispheres and descent of the confluence of sinuses were observed, but not vermis development. The primary pathology of dandy-walker syndrome is posterior cranial fossa cyst formation due to passage obstruction in the fourth ventricle exit area and aplasia of the lower cerebellar vermis. The first choice of treatment in patients with dandy-walker syndrome in whom the cerebral aqueduct is open is cystoperitoneal shunt surgery, regardless of the presence or absence of hydrocephalus.- - - - - - - - - - ranking = 0.00010267278114096keywords = area (Clic here for more details about this article) |
5/201. Spontaneous pneumocephalus in the posterior fossa in a patient with a ventriculoperitoneal shunt: case report.OBJECTIVE AND IMPORTANCE: A unique case of spontaneous pneumocephalus is described. It appeared a few years after the uneventful introduction of a cerebrospinal fluid shunt and was probably attributable to a defect of the posterior mastoid plate. CLINICAL PRESENTATION: A 65-year-old man presented with a subacute onset of vertigo, vomiting, and atactic gait instability. The patient had undergone a ventriculoperitoneal shunt implantation 2 years previously for communicating hydrocephalus. A computed tomographic scan revealed a posterior fossa pneumatocele without hydrocephalus. INTERVENTION: A simple mastoidectomy was performed. Detection of the area of the bone defect was followed by mastoid obliteration with abdominal fat. CONCLUSION: Clinicians should be aware that pneumocephalus can occur spontaneously, with or without obvious shunt problems. Treatment should be directed toward the area through which air penetrated the posterior fossa.- - - - - - - - - - ranking = 0.00020534556228193keywords = area (Clic here for more details about this article) |
6/201. flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign. Report of five cases.This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9-15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.- - - - - - - - - - ranking = 9.9782585727794E-5keywords = chest (Clic here for more details about this article) |
7/201. 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).- - - - - - - - - - ranking = 0.16676933944781keywords = plexus, area (Clic here for more details about this article) |
8/201. Shunt tube problems due to placement of valves on the chest wall--three case reports.Programmable valves are often used for ventriculoperitoneal (VP) shunts with the shunt valve positioned on the chest wall. Three cases of shunt problems occurred due to placement of the valve on the chest wall. A 43-year-old male was treated with a VP shunt, and suffered shunt malfunction due to dislocation of the ventricular tube. A 21-year-old male was treated with a VP shunt, and suffered shunt malfunction due to disconnection of the shunt tube. A 4-day-old female neonate was treated with a VP shunt, and suffered migration of the shunt valve. The shunt system has two anchor sites on the head and chest wall, with the neck between the two anchor sites. High tension is sometimes caused in the shunt tube between the two points due to movement of the neck or growth, and may induce such dislocation and disconnection of the shunt tube. We recommend a longer shunt tube in such cases.- - - - - - - - - - ranking = 0.00069847810009455keywords = chest (Clic here for more details about this article) |
9/201. adult rhombencephalosynapsis. Case report.Rhombencephalosynapsis (RS) is a relatively rare developmental disorder of the cerebellum in which the cerebellar hemispheres are fused across the midline without being separated by a cleft or the vermis. The condition may be associated with hydrocephalus and other intracranial and extracranial abnormalities. The authors report on the case of a symptomatic adult who was successfully treated with suboccipital decompression and duraplasty. A 39-year-old woman presented with intractable pain radiating from the thoracolumbar column to the occiput. A general examination yielded normal findings and a neurological examination revealed only subtle ataxia of tandem gait. The patient underwent magnetic resonance (MR) imaging, the results of which revealed an absent cerebellar vermis with fusion of the cerebellum and mild hydrocephalus. A cine-MR image obtained to evaluate her cerebrospinal fluid flow (CSF) revealed attenuated flow in the posterior fossa and cerebral aqueduct. Preoperative intracranial pressure (ICP) monitoring demonstrated no elevation of ICP (mean 4.3 mm Hg). The patient consented to undergo suboccipital craniectomy and duraplasty. Despite an increase in postoperative ICP (mean 10.77 mm Hg; difference from preoperative level according to a t-test, p = 0.002), the patient experienced symptomatic relief, which has persisted for 3 years. One year postoperatively, a cine-MR image was obtained, which revealed improvement in the patient's CSF dynamics. The authors conclude that, although RS may cause altered flow in the adult, their patient has experienced symptomatic relief, suggesting that her pain was related to local pressure in the posterior fossa.- - - - - - - - - - ranking = 0.00012031915389073keywords = pain (Clic here for more details about this article) |
10/201. Successful neuroendoscopic third ventriculostomy for hydrocephalus and syringomyelia associated with fourth ventricle outlet obstruction. Case report.The authors report the use of neuroendoscopic third ventriculostomy to treat successfully both hydrocephalus and syringomyelia associated with fourth ventricle outlet obstruction. A 27-year-old woman presented with dizziness, headache, and nausea. Magnetic resonance (MR) imaging demonstrated dilation of all ventricles, downward displacement of the third ventricular floor, obliteration of the retrocerebellar cerebrospinal fluid (CSF) space, funnellike enlargement of the entrance of the central canal in the fourth ventricle, and syringomyelia involving mainly the cervical spinal cord. Cine-MR imaging indicated patency of the aqueduct and an absent CSF flow signal in the area of the cistema magna, which indicated obstruction of the outlets of the fourth ventricle. Although results of radioisotope cisternography indicated failure of CSF absorption, neuroendoscopic third ventriculostomy completely resolved all symptoms as well as the ventricular and spinal cord abnormalities evident on MR images. Neuroendoscopic third ventriculostomy is an important option for treating hydrocephalus in patients with fourth ventricle outlet obstruction.- - - - - - - - - - ranking = 0.00010267278114096keywords = area (Clic here for more details about this article) |
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