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Ioan Stefan Florian - One of the best experts on this subject based on the ideXlab platform.

  • Evaluation of the ventriculocholecystic shunt—an overview of present practice in adult and pediatric hydrocephalus
    Neurosurgical Review, 2021
    Co-Authors: Cezar Octavian Morosanu, Adelina Priscu, Ioan Stefan Florian
    Abstract:

    In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for Cerebrospinal Fluid Diversion.

  • Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus.
    Neurosurgical review, 2021
    Co-Authors: Cezar Octavian Morosanu, Adelina Priscu, Ioan Stefan Florian
    Abstract:

    In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for Cerebrospinal Fluid Diversion.

  • From the heart to the bladder—particularities of ventricular shunt topography and the current status of Cerebrospinal Fluid Diversion sites
    Neurosurgical Review, 2020
    Co-Authors: Cezar Octavian Morosanu, Gabriela Adriana Filip, Liviu Nicolae, Ioan Stefan Florian
    Abstract:

    Hydrocephalus represents the pathological elevation of Cerebrospinal Fluid (CSF) levels as a consequence of various embryological or acquired defects. Although the classic method of treatment is by means of diverting the CSF from the ventricular system towards the peritoneum, there are other sites of Diversion that have proven their efficiency through time, in the context of complications related to the more common option of intraperitoneal insertion. The aim of the review is to assess and organize a database of all the types of shunt locations from the oldest shunt attempts until present, using Pubmed and Medline and to underline the particularities related to technique, indications, complications and associated epidemiological background. Current literature reveals up to 36 sites of Diversion of CSF with a diverse topography varying from cephalic regions such as venous sinuses or mastoid bone, thoracic elements such as the heart or the pleura and abdominopelvic segments such as the peritoneum or the urinary bladder. Several atypical locations were studied such as the fallopian and intestinal shunts. Although ventriculoperitoneal and ventriculoatrial shunts are the most commonly used shunts today, there are some systems such as the ventriculosinusal and ventriculolymphatic shunts that prove to be equally as efficient. The successful treatment of hydrocephalus requires a complete comprehension of the indications and therapeutic options and a reliable evaluation of the risks and possible complications. The profile of cerebral ventricular shunts is highly dynamic and the spectrum of Cerebrospinal Fluid Diversion offers multiple solutions in the benefit of the patient.

  • from the heart to the bladder particularities of ventricular shunt topography and the current status of Cerebrospinal Fluid Diversion sites
    Neurosurgical Review, 2020
    Co-Authors: Cezar Octavian Morosanu, Gabriela Adriana Filip, Liviu Nicolae, Ioan Stefan Florian
    Abstract:

    Hydrocephalus represents the pathological elevation of Cerebrospinal Fluid (CSF) levels as a consequence of various embryological or acquired defects. Although the classic method of treatment is by means of diverting the CSF from the ventricular system towards the peritoneum, there are other sites of Diversion that have proven their efficiency through time, in the context of complications related to the more common option of intraperitoneal insertion. The aim of the review is to assess and organize a database of all the types of shunt locations from the oldest shunt attempts until present, using Pubmed and Medline and to underline the particularities related to technique, indications, complications and associated epidemiological background. Current literature reveals up to 36 sites of Diversion of CSF with a diverse topography varying from cephalic regions such as venous sinuses or mastoid bone, thoracic elements such as the heart or the pleura and abdominopelvic segments such as the peritoneum or the urinary bladder. Several atypical locations were studied such as the fallopian and intestinal shunts. Although ventriculoperitoneal and ventriculoatrial shunts are the most commonly used shunts today, there are some systems such as the ventriculosinusal and ventriculolymphatic shunts that prove to be equally as efficient. The successful treatment of hydrocephalus requires a complete comprehension of the indications and therapeutic options and a reliable evaluation of the risks and possible complications. The profile of cerebral ventricular shunts is highly dynamic and the spectrum of Cerebrospinal Fluid Diversion offers multiple solutions in the benefit of the patient.

Cezar Octavian Morosanu - One of the best experts on this subject based on the ideXlab platform.

  • Evaluation of the ventriculocholecystic shunt—an overview of present practice in adult and pediatric hydrocephalus
    Neurosurgical Review, 2021
    Co-Authors: Cezar Octavian Morosanu, Adelina Priscu, Ioan Stefan Florian
    Abstract:

    In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for Cerebrospinal Fluid Diversion.

  • Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus.
    Neurosurgical review, 2021
    Co-Authors: Cezar Octavian Morosanu, Adelina Priscu, Ioan Stefan Florian
    Abstract:

    In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for Cerebrospinal Fluid Diversion.

  • Extended lumbar drainage in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis of diagnostic test accuracy.
    British journal of neurosurgery, 2020
    Co-Authors: Adam Nunn, Cezar Octavian Morosanu, Hayley E Jones, William G. B. Singleton, Michael A. Williams, Sean J. Nagel, Mark G. Luciano, Thomas J. Zwimpfer, Richard Holubkov, Jeffrey H. Wisoff
    Abstract:

    When appropriately selected, a high proportion of patients with suspected idiopathic normal pressure hydrocephalus (iNPH) will respond to Cerebrospinal Fluid Diversion with a shunt. Extended lumbar...

  • From the heart to the bladder—particularities of ventricular shunt topography and the current status of Cerebrospinal Fluid Diversion sites
    Neurosurgical Review, 2020
    Co-Authors: Cezar Octavian Morosanu, Gabriela Adriana Filip, Liviu Nicolae, Ioan Stefan Florian
    Abstract:

    Hydrocephalus represents the pathological elevation of Cerebrospinal Fluid (CSF) levels as a consequence of various embryological or acquired defects. Although the classic method of treatment is by means of diverting the CSF from the ventricular system towards the peritoneum, there are other sites of Diversion that have proven their efficiency through time, in the context of complications related to the more common option of intraperitoneal insertion. The aim of the review is to assess and organize a database of all the types of shunt locations from the oldest shunt attempts until present, using Pubmed and Medline and to underline the particularities related to technique, indications, complications and associated epidemiological background. Current literature reveals up to 36 sites of Diversion of CSF with a diverse topography varying from cephalic regions such as venous sinuses or mastoid bone, thoracic elements such as the heart or the pleura and abdominopelvic segments such as the peritoneum or the urinary bladder. Several atypical locations were studied such as the fallopian and intestinal shunts. Although ventriculoperitoneal and ventriculoatrial shunts are the most commonly used shunts today, there are some systems such as the ventriculosinusal and ventriculolymphatic shunts that prove to be equally as efficient. The successful treatment of hydrocephalus requires a complete comprehension of the indications and therapeutic options and a reliable evaluation of the risks and possible complications. The profile of cerebral ventricular shunts is highly dynamic and the spectrum of Cerebrospinal Fluid Diversion offers multiple solutions in the benefit of the patient.

  • from the heart to the bladder particularities of ventricular shunt topography and the current status of Cerebrospinal Fluid Diversion sites
    Neurosurgical Review, 2020
    Co-Authors: Cezar Octavian Morosanu, Gabriela Adriana Filip, Liviu Nicolae, Ioan Stefan Florian
    Abstract:

    Hydrocephalus represents the pathological elevation of Cerebrospinal Fluid (CSF) levels as a consequence of various embryological or acquired defects. Although the classic method of treatment is by means of diverting the CSF from the ventricular system towards the peritoneum, there are other sites of Diversion that have proven their efficiency through time, in the context of complications related to the more common option of intraperitoneal insertion. The aim of the review is to assess and organize a database of all the types of shunt locations from the oldest shunt attempts until present, using Pubmed and Medline and to underline the particularities related to technique, indications, complications and associated epidemiological background. Current literature reveals up to 36 sites of Diversion of CSF with a diverse topography varying from cephalic regions such as venous sinuses or mastoid bone, thoracic elements such as the heart or the pleura and abdominopelvic segments such as the peritoneum or the urinary bladder. Several atypical locations were studied such as the fallopian and intestinal shunts. Although ventriculoperitoneal and ventriculoatrial shunts are the most commonly used shunts today, there are some systems such as the ventriculosinusal and ventriculolymphatic shunts that prove to be equally as efficient. The successful treatment of hydrocephalus requires a complete comprehension of the indications and therapeutic options and a reliable evaluation of the risks and possible complications. The profile of cerebral ventricular shunts is highly dynamic and the spectrum of Cerebrospinal Fluid Diversion offers multiple solutions in the benefit of the patient.

Laligam N Sekhar - One of the best experts on this subject based on the ideXlab platform.

  • Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports.
    Neurosurgery, 2012
    Co-Authors: Manuel Ferreira, Brian P. Walcott, Brian V. Nahed, Maya A Babu, Richard G Ellenbogen, Laligam N Sekhar
    Abstract:

    Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal Cerebrospinal Fluid Diversion. These patients had no evidence of infection of the Cerebrospinal Fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal Cerebrospinal Fluid Diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal Cerebrospinal Fluid Diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

  • Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports.
    Neurosurgery, 2011
    Co-Authors: Manuel Ferreira, Brian P. Walcott, Brian V. Nahed, Maya A Babu, Richard G Ellenbogen, Laligam N Sekhar
    Abstract:

    Background and importance Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. Clinical presentation A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal Cerebrospinal Fluid Diversion. These patients had no evidence of infection of the Cerebrospinal Fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal Cerebrospinal Fluid Diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Conclusion Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal Cerebrospinal Fluid Diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

Brian P. Walcott - One of the best experts on this subject based on the ideXlab platform.

  • Retrograde third ventriculocisternostomy from the posterior fossa.
    Neurosurgery, 2013
    Co-Authors: Vijay Yanamadala, Brian P. Walcott, Brian V. Nahed, Fred G. Barker
    Abstract:

    Postoperative hydrocephalus is common in patients after resection of a posterior fossa tumor, with as many as 25% of patients requiring permanent Cerebrospinal Fluid Diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent postoperative hydrocephalus. To define the technique of microsurgical retrograde third ventriculostomy from the posterior fossa. The operative technique is described and a single patient with 4-year follow-up is reported. We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern via a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision. Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent Cerebrospinal Fluid Diversion and in whom exposure of the interpeduncular cistern is available.

  • Retrograde third ventriculocisternostomy from the posterior fossa.
    Operative Neurosurgery, 2012
    Co-Authors: Vijay Yanamadala, Brian P. Walcott, Brian V. Nahed, Fred G. Barker
    Abstract:

    BACKGROUND Postoperative hydrocephalus is common in patients after resection of a posterior fossa tumor, with as many as 25% of patients requiring permanent Cerebrospinal Fluid Diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent postoperative hydrocephalus. OBJECTIVE To define the technique of microsurgical retrograde third ventriculostomy from the posterior fossa. METHODS The operative technique is described and a single patient with 4-year follow-up is reported. RESULTS We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern via a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision. CONCLUSION Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent Cerebrospinal Fluid Diversion and in whom exposure of the interpeduncular cistern is available.

  • Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports.
    Neurosurgery, 2012
    Co-Authors: Manuel Ferreira, Brian P. Walcott, Brian V. Nahed, Maya A Babu, Richard G Ellenbogen, Laligam N Sekhar
    Abstract:

    Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal Cerebrospinal Fluid Diversion. These patients had no evidence of infection of the Cerebrospinal Fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal Cerebrospinal Fluid Diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal Cerebrospinal Fluid Diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

  • Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports.
    Neurosurgery, 2011
    Co-Authors: Manuel Ferreira, Brian P. Walcott, Brian V. Nahed, Maya A Babu, Richard G Ellenbogen, Laligam N Sekhar
    Abstract:

    Background and importance Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. Clinical presentation A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal Cerebrospinal Fluid Diversion. These patients had no evidence of infection of the Cerebrospinal Fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal Cerebrospinal Fluid Diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Conclusion Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal Cerebrospinal Fluid Diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

Brian V. Nahed - One of the best experts on this subject based on the ideXlab platform.

  • Retrograde third ventriculocisternostomy from the posterior fossa.
    Neurosurgery, 2013
    Co-Authors: Vijay Yanamadala, Brian P. Walcott, Brian V. Nahed, Fred G. Barker
    Abstract:

    Postoperative hydrocephalus is common in patients after resection of a posterior fossa tumor, with as many as 25% of patients requiring permanent Cerebrospinal Fluid Diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent postoperative hydrocephalus. To define the technique of microsurgical retrograde third ventriculostomy from the posterior fossa. The operative technique is described and a single patient with 4-year follow-up is reported. We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern via a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision. Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent Cerebrospinal Fluid Diversion and in whom exposure of the interpeduncular cistern is available.

  • Retrograde third ventriculocisternostomy from the posterior fossa.
    Operative Neurosurgery, 2012
    Co-Authors: Vijay Yanamadala, Brian P. Walcott, Brian V. Nahed, Fred G. Barker
    Abstract:

    BACKGROUND Postoperative hydrocephalus is common in patients after resection of a posterior fossa tumor, with as many as 25% of patients requiring permanent Cerebrospinal Fluid Diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent postoperative hydrocephalus. OBJECTIVE To define the technique of microsurgical retrograde third ventriculostomy from the posterior fossa. METHODS The operative technique is described and a single patient with 4-year follow-up is reported. RESULTS We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern via a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision. CONCLUSION Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent Cerebrospinal Fluid Diversion and in whom exposure of the interpeduncular cistern is available.

  • Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports.
    Neurosurgery, 2012
    Co-Authors: Manuel Ferreira, Brian P. Walcott, Brian V. Nahed, Maya A Babu, Richard G Ellenbogen, Laligam N Sekhar
    Abstract:

    Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal Cerebrospinal Fluid Diversion. These patients had no evidence of infection of the Cerebrospinal Fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal Cerebrospinal Fluid Diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal Cerebrospinal Fluid Diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

  • Trapped fourth ventricle phenomenon following aneurysm rupture of the posterior circulation: case reports.
    Neurosurgery, 2011
    Co-Authors: Manuel Ferreira, Brian P. Walcott, Brian V. Nahed, Maya A Babu, Richard G Ellenbogen, Laligam N Sekhar
    Abstract:

    Background and importance Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. Clinical presentation A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal Cerebrospinal Fluid Diversion. These patients had no evidence of infection of the Cerebrospinal Fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal Cerebrospinal Fluid Diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. Conclusion Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal Cerebrospinal Fluid Diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.