scholarly journals Acute triventricular hydrocephalus caused by choroid plexus cysts: a diagnostic and neurosurgical challenge

2016 ◽  
Vol 41 (5) ◽  
pp. E9 ◽  
Author(s):  
Pietro Spennato ◽  
Carmela Chiaramonte ◽  
Domenico Cicala ◽  
Vittoria Donofrio ◽  
Manlio Barbarisi ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Endoscopic Surgery ◽  
External Ventricular Drain ◽  
Third Ventricle ◽  
Posterior Part ◽  
Case Series ◽  
Complete Removal ◽  
Radiological Diagnosis ◽  
Foramen Of Monro ◽  
Triventricular Hydrocephalus

OBJECTIVE Intraventricular choroid plexus cysts are unusual causes of acute hydrocephalus in children. Radiological diagnosis of intraventricular choroid plexus cysts is difficult because they have very thin walls and fluid contents similar to CSF and can go undetected on routine CT studies. METHODS This study reports the authors' experience with 5 patients affected by intraventricular cysts originating from the choroid plexus. All patients experienced acute presentation with rapid neurological deterioration, sometimes associated with hypothalamic dysfunction, and required urgent surgery. In 2 cases the symptoms were intermittent, with spontaneous remission and sudden clinical deteriorations, reflecting an intermittent obstruction of the CSF pathway. RESULTS Radiological diagnosis was difficult in these cases because a nonenhanced CT scan revealed only triventricular hydrocephalus, with slight lateral ventricle asymmetry in all cases. MRI with driven-equilibrium sequences and CT ventriculography (in 1 case) allowed the authors to accurately diagnose the intraventricular cysts that typically occupied the posterior part of the third ventricle, occluding the aqueduct and at least 1 foramen of Monro. The patients were managed by urgent implantation of an external ventricular drain in 1 case (followed by endoscopic surgery, after completing a diagnostic workup) and by urgent endoscopic surgery in 4 cases. Endoscopic surgery allowed the shrinkage and near-complete removal of the cysts in all cases. Use of neuronavigation and a laser were indispensable. All procedures were uneventful, resulting in restoration of normal neurological conditions. Long-term follow-up (> 2 years) was available for 2 patients, and no complications or recurrences occurred. CONCLUSIONS This case series emphasizes the necessity of an accurate and precise identification of the possible causes of triventricular hydrocephalus. Endoscopic surgery can be considered the ideal treatment of choroid plexus cysts in children.

scholarly journals Intraventricular Tumor: An Analysis of 18 Cases

2016 ◽  
Vol 13 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Shamsul Alam ◽  
Abu NW Uddin ◽  
Mashiur R Majumder ◽  
Md M Hasan ◽  
Anis Ahmed
Keyword(s):  
Anterior Part ◽  
Third Ventricle ◽  
Posterior Part ◽  
Foramen Of Monro ◽  
Intraventricular Tumors ◽  
Piecemeal Resection ◽  
Neurovascular Structures ◽  
Tumor Debulking ◽  
Neurosurgical Techniques ◽  
Transcortical Approach

The main objective of this article is to describe transcallosal and transcortical approach to deal with intraventricular tumors.Details of the transcallosal and transcortical approach to intraventricular tumors of the lateral and third ventricles were presented.Intraventricular tumors are ideal indications for microscopic neurosurgery. They often cause cerebrospinal fluid (CSF) pathway obstruction, resulting in ventricular dilatation. The general principle of removal of intraventricular tumors is interruption of the blood supply to the tumor and subsequent tumor debulking. In general, a piecemeal resection was performed; however, in some tumors such as meningioma, it was possible to detach the lesion from the surrounding brain tissue and remove it in toto. When the tumor arised in the anterior part of the third ventricle, the craniotomy was made at the coronal suture. When the tumor is located in the posterior part, the entry craniotomy was selected more anteriorly in order to pass the foramen of Monro in a straight line.Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with micro neurosurgical techniques, either by transcallosal or transcortical approach. The aim should be the total extraction of the tumor with minimum damage and the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures. Lateral ventricle tumors can be removed via transcortical approach when having hydrocephalus which provides a wider and more direct approach to the tumor than the transcallosal one. It allows the surgeon to achieve good functional outcome and maximum excision of the tumor. Transcallosal is an excellent midline exposure with preserving the callosomerginal and pericallosal arteriesto the midline tumor of lateral and 3rd ventricles.Nepal Journal of Neuroscience 13:23-29, 2016

Microsurgical anatomy of the choroidal arteries: Lateral and third ventricles

1980 ◽  
Vol 52 (2) ◽  
pp. 165-188 ◽  
Author(s):  
Kiyotaka Fujii ◽  
Carla Lenkey ◽  
Albert L. Rhoton
Keyword(s):  
Choroid Plexus ◽  
Third Ventricle ◽  
Posterior Part ◽  
Optic Tract ◽  
Lateral Geniculate Body ◽  
The Body ◽  
Cerebral Peduncle ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Choroidal Artery

✓ The microsurgical anatomy of the arteries supplying the choroid plexus of the lateral and third ventricles was examined in 50 formalin-fixed cerebral hemispheres using × 3 to × 20 magnification. There was marked variation in the area of choroid plexus supplied by the choroidal arteries; however, the most common pattern was for the anterior choroidal artery (AChA) to supply a portion of the choroid plexus in the inferior horn and part of the atrium; the lateral posterior choroidal artery (LPChA) to supply a portion of the choroid plexus in the atrium and posterior part of the temporal horn and body; and the medial posterior choroidal artery (MPChA) to supply the choroid plexus in the roof of the third ventricle and a portion of that in the body of the lateral ventricle. The LPChA's and MPChA's occasionally sent branches to the choroid plexus on the contralateral side. The most frequent neural branches of the three choroidal arteries were as follows: AChA branches to the optic tract, cerebral peduncle, temporal lobe, and lateral geniculate body; LPChA branches to the thalamus, geniculate bodies, fornix, and cerebral peduncles; and MPChA branches to the thalamus, pineal body, cerebral peduncle, and tegmentum of the midbrain. Each of the choroidal arteries was divided into a cisternal and plexal segment. The cisternal segments were the most common site of origin of neural branches, but they also gave rise to some plexal branches. The plexal segments occasionally gave rise to neural branches.

Bobble—head doll syndrome and drop attacks in a child with a cystic choroid plexus papilloma of the third ventricle

1995 ◽  
Vol 83 (4) ◽  
pp. 729-732 ◽  
Author(s):  
Ian F. Pollack ◽  
Nina F. Schor ◽  
A. Julio Martinez ◽  
Richard Towbin
Keyword(s):  
Choroid Plexus ◽  
Third Ventricle ◽  
Choroid Plexus Papilloma ◽  
Head Tilt ◽  
Foramen Of Monro ◽  
Drop Attacks ◽  
Content Type ◽  
The Third ◽  
Head Bobbing ◽  
Plexus Papilloma

✓ The authors report an unusual case of a 2-year-old boy with a 3-month history of episodic rightward anterolateral head tilt and large-amplitude positional anteroposterior head bobbing reminiscent of bobble—head doll syndrome. This child experienced a sudden onset of drop attacks and then, within several hours, deep coma. The causative lesion was a contrast-enhancing, partially cystic third ventricular mass, which ultimately obstructed the aqueduct, producing profound obstructive hydrocephalus. An emergency ventriculostomy and endoscopic fenestration of the septum pellucidum was performed. Four days later, the tumor was completely resected by a transcallosal—transforaminal approach. The lesion was freely mobile within the third ventricle and contained a large cyst within its posterior pole; following drainage of the cyst, the lesion was easily delivered through the foramen of Monro. The histopathological diagnosis was choroid plexus papilloma. The child's neurological deficits, head tilt, and head bobbing resolved immediately after operation. To the best of the authors' knowledge, this represents the first well-documented report of bobble—head doll syndrome and drop attacks secondary to a choroid plexus papilloma. The highly mobile nature of the cystic lesion presumably led to its intermittent impaction within the foramen of Monro and/or proximal aqueduct; this produced the intermittent head tilt and bobble-head symptoms and, ultimately, resulted in acute obstruction of the aqueduct, causing the child's precipitous neurological decline.

scholarly journals Third ventricle colloid cysts: An endoscopic case series emphasizing technical variations

2021 ◽  
Vol 12 ◽  
pp. 376
Author(s):  
Samuel Tau Zymberg ◽  
Guilherme Salemi Riechelmann ◽  
Marcos Devanir Silva da Costa ◽  
Clauder Oliveira Ramalho ◽  
Sergio Cavalheiro
Keyword(s):  
Endoscopic Surgery ◽  
Third Ventricle ◽  
Case Series ◽  
Limited Resource ◽  
Gross Total Resection ◽  
Preoperative Imaging ◽  
Subtotal Resection ◽  
Total Resection ◽  
Female Ratio ◽  
Colloid Cysts

Background: Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to assess the results of endoscopic surgery using mainly aspiration and coagulation without complete capsule resection and discuss the rationale for the procedure. Methods: A retrospective review was conducted of 45 consecutive symptomatic patients with third ventricle colloid cysts that were surgically treated with purely endoscopic surgery from 1997 to 2018. Results: Mean age was 35.4 years. Male-to-female ratio was 1:1. Clinical presentation included predominantly headache (80%). Transforaminal was the most used route (71.1%) followed by transeptal (24.5%) and interforniceal (4.4%). Capsule was intentionally not removed in 42 patients (93.3%) and cyst remnants were absent on postoperative MRI in 36 (85%). Mild complications occurred in 8 patients (17.8%). Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications, shunts or deaths. Follow-up did not show any recurrence or remnant growth that needed further treatment. Conclusion: Gross total resection may not be the main objective for every situation. Subtotal resection without capsule removal seems to be safer while preserving good results, especially in a limited resource environment. Remnants left behind should be followed but tend to remain clinically asymptomatic for the most part. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings.

scholarly journals Intraventricular Tumor: An Analysis of 18 Cases

2015 ◽  
Vol 31 (2) ◽  
pp. 94-101
Author(s):  
Shamsul Alam ◽  
AN Wakil Uddin ◽  
Mashiur Rahman Majumder ◽  
Md Motasimul Hasan ◽  
Anis Ahmed
Keyword(s):  
Anterior Part ◽  
Third Ventricle ◽  
Posterior Part ◽  
Foramen Of Monro ◽  
Straight Line ◽  
Intraventricular Tumors ◽  
Piecemeal Resection ◽  
Neurovascular Structures ◽  
Tumor Debulking ◽  
Transcortical Approach

Objective: To describe the transcallosal and transcortical approach to deal with intraventricular tumors. Methods: Details of the transcallosal and transcortical approach to intraventricular tumors of the lateral and third ventricles were presented. Results: Intraventricular tumors are ideal indications for microscopic neurosurgery. They often cause cerebrospinal fluid (CSF) pathway obstruction, resulting in ventricular dilatation. The general principle of removal of intraventricular tumors was interruption of the blood supply to the tumor and subsequent tumor debulking. In general, a piecemeal resection was performed; however, in some tumors such as meningioma, it was possible to detach the lesion from the surrounding brain tissue and remove it in toto. When the tumor found in the anterior part of the third ventricle, the craniotomy was done at the coronal suture. When the tumor was located in the posterior part, the entry craniotomy was selected more anteriorly in order to pass the foramen of Monro in a straight line. Conclusion: Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with micro neurosurgical techniques, either by transcallosal or transcortical approach. The aim should be the total extraction of the tumor with minimum damage and the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures. Lateral ventricle tumors can be removed via transcortical approach when having hydrocephalus which provides a wider and more direct approach to the tumor than the transcallosal one. It allows the surgeon to achieve good functional outcome and maximum excision of the tumor. Transcallosal is an excellent midline exposure with preserving the callosomerginal and pericallosal arteriesto the midline tumor of lateral and 3rd ventricles. Bangladesh Journal of Neuroscience 2015; Vol. 31 (2): 94-101

scholarly journals Lesions at the Foramen of Monro Causing Obstructive Hydrocephalus

2021 ◽  
Author(s):  
Ashish Chugh ◽  
Sarang Gotecha ◽  
Prashant Punia ◽  
Neelesh Kanaskar
Keyword(s):  
Choroid Plexus ◽  
Intraventricular Hemorrhage ◽  
Anterior Part ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Subependymal Giant Cell Astrocytoma ◽  
Foramen Of Monro ◽  
The Third ◽  
Giant Cell Astrocytoma

The foramen of Monro has also been referred to by the name of interventricular foramen. The structures comprising this foramen are the anterior part of the thalamus, the fornix and the choroid plexus. Vital structures surround the foramen, the damage to which can be catastrophic leading to disability either temporary or permanent. In the literature it has been shown that tumors occurring in the area of interventricular foramen are rare and usually cause hydrocephalus. The operative approach depends upon the location of the tumor which can be either in the lateral or the third ventricle. Various pathologies which can lead to foramen of Monro obstruction and obstructive hydrocephalus include colloid cyst, craniopharyngioma, subependymal giant cell astrocytoma [SEGA], Neurocysticercosis, tuberculous meningitis, pituitary macroadenoma, neurocytoma, ventriculitis, multiseptate hydrocephalus, intraventricular hemorrhage, functionally isolated ventricles, choroid plexus tumors, subependymomas and idiopathic foramen of monro stenosis. In this chapter, we will discuss the various lesions at the level of foramen of Monro causing obstructive hydrocephalus and the management and associated complications of these lesions based on their type, clinical picture and their appearance on imaging.

Choroid plexus cyst and chordoid glioma

2001 ◽  
Vol 10 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Fadi Hanbali ◽  
Gregory N. Fuller ◽  
Norman E. Leeds ◽  
Raymond Sawaya
Keyword(s):  
Choroid Plexus ◽  
Lateral Ventricle ◽  
Short Term Memory ◽  
Third Ventricle ◽  
Cancer Center ◽  
Foramen Of Monro ◽  
The Third ◽  
Chordoid Glioma ◽  
Choroid Plexus Cyst

Several types of mass lesions may occur in the third and lateral ventricles. Typically they arise from the lining of the ventricular cavity or from contiguous structures, by extension into the ventricle. The authors describe two patients, each of whom presented with a different rare lesion of the ventricular system. The first was a 53-year-old woman with a history of hypertension who sustained a blunt traumatic injury to the occipital region and subsequently developed a progressively worsening right-sided headache. Radiological examinations over the next 2 years revealed an enlarged right lateral ventricle and, ultimately, a choroid plexus cyst in its anterior and middle third, near the foramen of Monro, which is a rare location for these lesions. The cyst was removed en bloc, and follow-up examinations showed a significant improvement in her headache and a minimal differences in size between right and left ventricles. The authors also describe a 57-year-old man with hypertension, diabetes mellitus, and an old mycardial infarct, who presented to an outside institution with a progressively worsening headache, generalized malaise, and loss of olfactory sensation. Diagnostic imaging revealed a 1.5-cm oval lesion centered in the lamina terminalis region, an open craniotomy was performed, and evaluation of a biopsy sample demonstrated the mass to be a chordoid glioma of the third ventricle, a recently described glioma subtype. Two days after surgery, he suffered a left parietal stroke and an anterior mycardial infarction. After convalescing, he presented to The University of Texas M. D. Anderson Cancer Center for radiotherapy and follow up; 7 months later he was readmitted complaining of headache, short-term memory loss, and worsening confusion and disorientation. Neuroimaging revealed progression of the tumor (now 2 cm in diameter), which was removed by gross-total resection. His headache resolved immediately, and 2 months later his only complaint was of episodes of confusion. Three weeks later he died of a massive myocardial infarction. These two patients represent the sixth case of an adult with a choroid plexus cyst in the anterior lateral ventricle and the 19th case of an adult with a chordoid glioma of the third ventricle, respectively.

Multiple Colloid Cysts: Case Report and Literature Review

2018 ◽  
Vol 79 (06) ◽  
pp. 536-540
Author(s):  
Martin Bettag ◽  
Ahmed Rizk
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Complete Removal ◽  
Ventricular Catheter ◽  
Foramen Of Monro ◽  
The Third ◽  
Colloid Cysts ◽  
Magnetic Resonance Imaging Mri ◽  
Clinical Description ◽  
The Right

Background and Study Aim Colloid cysts usually occur in the anterior third ventricle at the level of the foramina of Monro. Colloid cysts may extend from the third toward the lateral ventricle. We present a rare case of multiple intraventricular colloid cysts, two of which were in the third ventricle and one in the lateral ventricle. Clinical Description A 40-year-old female patient presented with three intraventricular cystic lesions: one cyst in the typical localization in the anterior rostral third ventricle, another cyst behind it in the same (third) ventricle, and a larger bulging cyst in the right lateral ventricle. A bilateral ventriculoperitoneal shunt had been inserted 26 years before to treat hydrocephalus. All three cysts had different magnetic resonance imaging (MRI) signal characteristics. We removed the cysts through an endoscopically assisted right transcortical transventricular microsurgical approach, using the right ventricular catheter as a guide to the lateral ventricle. After removal of the lateral ventricular cyst, we observed that the foramen of Monro was greatly enlarged (most likely as a result of the large cyst), which allowed us to remove the cysts in the third ventricle. During surgery, the cysts were found to have different consistencies. MRI 2 years following surgery showed complete removal and no hydrocephalus. The patient had no symptoms, and the clinical examinations were normal. Conclusions Colloid cysts may become large and extend to the lateral ventricle, especially in patients treated with ventriculoperitoneal shunts. Studying the relevant pathoanatomy of these cysts is very important for preoperative planning including the choice of surgical approach.

Microsurgery of the Third Ventricle: Part 1

Neurosurgery ◽  
1981 ◽  
Vol 8 (3) ◽  
pp. 334-356 ◽  
Author(s):  
Isao Yamamoto ◽  
Albert L. Rhoton ◽  
David A. Peace
Keyword(s):  
Lateral Ventricle ◽  
Anterior Part ◽  
Third Ventricle ◽  
Posterior Part ◽  
Posterior Wall ◽  
Pineal Region ◽  
Circle Of Willis ◽  
Cerebral Vein ◽  
Foramen Of Monro ◽  
3Rd Ventricle

Abstract The 3rd ventricle is one of the most surgically inaccessible areas in the brain. It is impossible to reach its cavity without incising some neural structures. Twenty-five cadaveric brains were examined in detail to evaluate the surgically important relationships of the walls of the 3rd ventricle. The routes through which the 3rd ventricle can be reached are: (a) from above, through the foramen of Monro and the roof after entering the lateral ventricle through the corpus callosum or the cerebral cortex; (b) from anterior, through the lamina terminalis; (c) from below, through the floor if it has been stretched by tumor; and (d) from posterior, through the pineal region or from the posterior part of the lateral ventricle through the crus of the fornix. The posterior part of the circle of Willis and the basilar artery are intimately related to the floor, the anterior part of the circle of Willis and the anterior cerebral and anterior communicating arteries are related to the anterior wall, and the posterior cerebral artery supplies the posterior wall. The deep cerebral venous system is intimately related to the 3rd ventricle; the internal cerebral vein is related to the roof, and the basal vein is related to the floor. The junction of these veins with the great vein forms a formidable obstacle to the operative approach to the pineal gland and the posterior part of the 3rd ventricle.

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