Spontaneous third ventriculocisternostomy in an infant with obstructive hydrocephalus

Case report

Restricted access

✓Spontaneous ventriculocisternostomy, the spontaneous communication between the ventricular system and the subarachnoid space, is rare. The authors report a case of an infant with obstructive hydrocephalus who developed a spontaneous third ventriculocisternostomy. The infant was initially evaluated for progressive ventriculomegaly and increasing head circumference (HC). During follow-up, the patient's HC began to follow percentile lines and magnetic resonance (MR) imaging demonstrated a reduction of the hydrocephalus. Flow-sensitive phase-contrast cine MR images revealed cerebrospinal fluid (CSF) flow through the floor of the third ventricle between the tuber cinereum and the mammillary bodies connecting the ventricular system with the prepontine cistern. Although rare, clinicians should be cognizant of this phenomenon as it may eliminate the need for CSF diversion.

Abbreviations used in this paper: CSF = cerebrospinal fluid; HC = head circumference; MR = magnetic resonance.

Article Information

Address correspondence to: Gary L. Gallia, M.D., Ph.D., Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, Maryland 21287. email: ggallia1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    A and B: Proton density–weighted axial MR images obtained in the patient at 3 months of age demonstrating marked dilation of the third and lateral ventricles. C: Sagittal T1-weighted MR image demonstrating enlargement of the tectum causing obstructive hydrocephalus. D and E: Sagittal midline phase-contrast MR images showing no evidence of CSF flow through the floor of the third ventricle or the cerebral aqueduct.

  • View in gallery

    A and B: Axial Gd-enhanced T1-weighted MR images obtained at 19 months of age demonstrating a decrease in ventricular size. C and D: Sagittal midline phase-contrast MR images demonstrating CSF flow through the floor of the third ventricle. The middiastolic image (C) reveals caudocranial flow (white signal) of CSF through the floor of the third ventricle. The midsystolic image (D) demonstrates craniocaudal CSF flow (black signal) through the floor of the third ventricle.

  • View in gallery

    Axial T1-weighted MR images obtained at 44 months of age demonstrating continued resolution of ventriculomegaly.

References

  • 1

    Abe MUchino ATsuji TTabuchi K: Ventricular diverticula in obstructive hydrocephalus secondary to tumor growth. Neurosurgery 52:65712003

    • Search Google Scholar
    • Export Citation
  • 2

    Bhatia RBanerji AKRao M: Spontaneous rupture of the third ventricle in obstructive hydrocephalus: a radiographic diagnosis. Acta Neurochir (Wien) 39:1591651977

    • Search Google Scholar
    • Export Citation
  • 3

    de Lange C: Spontaneous healing in a case of hydrocephalus. Proc R Acad Amsterdam 32:78851929

  • 4

    Jabaudon DCharest DPorchet F: Pathogenesis and diagnostic pitfalls of ventricular diverticula: case report and review of the literature. Neurosurgery 52:2092122003

    • Search Google Scholar
    • Export Citation
  • 5

    Kapila ANaidich TP: Spontaneous lateral ventriculocisternostomy documented by metrizamide CT ventriculography. Case report. J Neurosurg 54:1011041981

    • Search Google Scholar
    • Export Citation
  • 6

    Kim LJFeiz-Erfan IClatterbuck RESpetzler RF: Spontaneous ventriculostomy in a patient with obstructive hydrocephalus. Acta Neurochir (Wien) 147:2192202005

    • Search Google Scholar
    • Export Citation
  • 7

    Leslie EVAlker GJ Jr: Spontaneous ventriculostomy. Radiology 83:6836861964

  • 8

    Liss LMervis L: Spontaneous ventriculostomy through lamina terminalis with arrest of hydrocephalus. A case report. J Neurosurg 23:2112131965

    • Search Google Scholar
    • Export Citation
  • 9

    Mann KSKhosla VKGulati DR: Congenital ventriculocisternostomy. Case report. J Neurosurg 54:981001981

  • 10

    Miller CF IIWhite RJRoski RA: Spontaneous ventriculocisternostomy. Surg Neurol 11:63661979

  • 11

    Naidich TPMcLone DGHahn YSHanaway J: Atrial diverticula in severe hydrocephalus. AJNR Am J Neuroradiol 3:2572661982

  • 12

    Rovira ACapellades JGrivé EPoca MAPedraza SSahuquillo J: Spontaneous ventriculostomy: report of three cases revealed by flow-sensitive phase-contrast cine MR imaging. AJNR Am J Neuroradiol 20:164716521999

    • Search Google Scholar
    • Export Citation
  • 13

    Sweet WH: Spontaneous cerebral ventriculostium. Arch Neurol Psychiatry 44:5325401940

  • 14

    Tandon PNHarkmark W: Spontaneous ventriculocisternostomy with relief of obstructive hydrocephalus. Neurology 9:6997031959

  • 15

    Wakai SNagai M: Ventricular diverticulum. J Neurol Neurosurg Psychiatry 47:5145171984

  • 16

    Zilkha A: Spontaneous ventriculostomy. Report of two cases demonstrated by Pantopaque ventriculography. Radiology 111:6336371974

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 127 127 41
Full Text Views 35 32 0
PDF Downloads 86 75 0
EPUB Downloads 0 0 0

PubMed

Google Scholar