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John R. Little, O. Wayne Houser, and Collin S. MacCarty

years (mean, 28 years). The symptoms and neurological findings at the initial evaluation are listed in Table 1 . TABLE 1 Clinical presentation, treatment, and follow-up of 17 patients with aqueductal stenosis Case No. Age, Sex Symptoms Neurological Findings Shunt Ventricle Follow-up 1 24 F headache (4 yr); endogenous depression (6 yr) normal cistern occasional headache (14 yr) 2 23 F headache (10 yr); blurred vision (5 wk) chronic papilledema cistern complete recovery (2 yr) 3 19 M

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John R. Little and Collin S. MacCarty

axial tomography performed 1 week postoperatively demonstrated normal-sized lateral ventricles ( Fig. 1 right ). The patient has been asymptomatic since dismissal from the hospital 12 months ago. Discussion Spontaneous CSF rhinorrhea is an uncommon phenomenon. 8 However, it occasionally is the presenting complaint of adult patients with chronic hydrocephalus secondary to aqueductal stenosis. 5, 8 This case was included in a previously reported series of adult patients with aqueductal stenosis. 5 To our knowledge, there has been one previous report

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Aneek Patel, Hussam Abou-Al-Shaar, Michael C. Chiang, Hanna N. Algattas, Michael M. McDowell, Jeremy G. Stone, Ellen B. Mitchell, Stephen P. Emery, and Stephanie Greene

H ydrocephalus is the most common reason for pediatric neurosurgical intervention in the United States, with an estimated incidence of 1 per 1000 newborns. 1 , 2 Various etiologies have been associated with neonatal hydrocephalus, including intraventricular hemorrhage (IVH), meningitis, spina bifida, mass lesions, and congenital aqueductal stenosis (CAS). Subgroup analyses of patients with a single etiology of hydrocephalus are lacking in the literature. Although similar in presentation and intervention, these etiologies vary in terms of age at diagnosis

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Orhan Barlas, Hüsameddin Gökay, M. İnan Turantan, and Nermin Başerer

T he constellation of episodic vertigo, tinnitus, and fluctuating hearing loss was described as a disorder of the inner ear in 1861 by Prosper Ménière. 10 We report two patients who presented with these three classic symptoms. Audiovestibulometric assessment of these two cases were indicative of inner ear disorder. Further investigations revealed aqueductal stenosis, and shunting procedures of the cerebrospinal fluid (CSF) resulted in resolution of the symptoms of the membranous inner ear disease. Although the association of inner ear disease and

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G. Robert Nugent, Ossama Al-Mefty, and Sam Chou

F or some time, neurologists and neurosurgeons have had difficulty in understanding the pathophysiology of non-neoplastic aqueductal stenosis of the older child and adult. The etiology is obscure; is it congenital or acquired? The clinical picture is nonspecific and varied, and bypassing the stenosis (Torkildsen's operation) frequently is not successful. 1, 4, 11 Why in some cases with partial stenosis of the aqueduct of Sylvius does hydrocephalus develop even though the stenosis seems to leave a sufficient conduit to transport cerebrospinal fluid at the rate

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Robert J. Dempsey, William F. Chandler, and Sue Ellyn Sauder

web with a small opening was demonstrated ( Fig. 2 ). Fig. 1. Preoperative anterior view of metrizamide ventriculogram showing focal ballooning of the third ventricle in the area of the hypothalamus. Fig. 2. Lateral view of preoperative metrizamide ventriculogram demonstrating aqueductal stenosis and an enlarged third ventricle. It was postulated that the patient's hydrocephalus with focal enlargement of the third ventricle in the region of the hypothalamus was the cause of her hypopituitarism. A ventriculoperitoneal shunt was inserted

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Patrick J. Kelly

computerized tomography (CT)-based third ventriculostomy with computer-assisted angiographic target-point cross-registration has been described previously. 24 The present paper reports the results obtained with this procedure in the management of patients with obstructive hydrocephalus due to nontumoral aqueductal stenosis of adolescent or adult onset. Clinical Material and Methods Clinical Material Sixteen consecutive patients with aqueductal stenosis of adolescent or adult onset underwent stereotactic third ventriculostomy between September, 1984, and December

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Susanne Guhl, Michael Kirsch, Heinz Lauffer, Michael Fritsch, and Henry W. S. Schroeder

D evelopmental venous anomalies are frequent incidental findings in cranial MR imaging. However, mesencephalic DVAs causing aqueductal stenosis with subsequent obstructive hydrocephalus are very rare. Only a few cases have been published previously. 11 We report on a 10-month-old boy presenting with hydrocephalus caused by compression of the aqueduct by a DVA of the perimesencephalic venous drainage system. These benign variations of the cerebral venous angioarchitecture are congenital. The term “developmental venous anomaly” is the synonym for venous

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Giuseppe Cinalli, Christian Sainte-Rose, Paul Chumas, Michel Zerah, Francis Brunelle, Guillaume LOT, Alain Pierre-Kahn, and Dominique Renier

S ince its first description by Dandy, 4 third ventriculostomy has been performed to treat obstructive triventricular hydrocephalus without implanting cerebrospinal fluid (CSF) shunt devices. The percutaneous technique, performed using ventriculographic guidance as described by Guiot and colleagues, 7, 8 made it possible for this procedure to be performed in large series of patients, allowing various indications for surgery to be identified. Patients with obstructive triventricular hydrocephalus due to primary aqueductal stenosis, toxoplasmosis, or

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Jarod L. Roland, Richard L. Price, Ashwin A. Kamath, S. Hassan Akbari, Eric C. Leuthardt, Brandon A. Miller, and Matthew D. Smyth

P ineal region and tectal tumors often present with hydrocephalus. Tumors of markedly different histopathology often present with similar symptomology due to hydrocephalus. Noncommunicating hydrocephalus typically occurs in this scenario secondary to closure of the cerebral aqueduct from an adjacent tumor. Other causes of new-onset hydrocephalus in the absence of neoplasm include infection, such as meningitis or ventriculitis, and aqueductal stenosis. Aqueductal stenosis is a common cause of congenital noncommunicating hydrocephalus. In young children with open