Disproportionately Large Communicating Fourth Ventricle Associated With Syringomyelia and Intradural Arachnoid Cyst in the Spinal Cord Successfully Treated With Additional Shunting

Yamashita, Tae; Hiramatsu, Hisaya; Kitahama, Yoshihiro; Tokuyama, Tsutomu; Sugiyama, Kenji; Namba, Hiroki

doi:10.2176/nmc.52.231

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…We must understand the possibility that conventional treatments for hydrocephalus such as ventricular drainage or VP shunt may lead to the expansion of the fourth ventricle and shrinkage of the lateral and third ventricles, as discussed above. 10 , 11 , 23 – 25) In the literature, ETV or placement of a fourth VP shunt was performed in 13 of 21 patients. Contrarily, we performed ETV as the first-line treatment for all patients with DLCFV.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment Strategy for a Disproportionately Large Communicating Fourth Ventricle: Case Series and Literature Review

Kawabata

Takeuchi

Nagata

et al. 2020

Neurol. Med. Chir.(Tokyo)

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An isolated fourth ventricle (IFV) is characterized by fourth ventricular dilation due to obstruction of its inlet and outlet. A disproportionately large communicating fourth ventricle (DLCFV) is a rare subtype of IFV, characterized by dilation of the fourth ventricle, regardless of the size of the lateral ventricles, with no apparent obstruction of the cerebral aqueduct. To our knowledge, this is the first case series describing endoscopic diagnosis and treatment strategy for DLCFV. We retrospectively reviewed six cases of DLCFV in which endoscopic surgery was performed at our institution and affiliated facilities between June 2013 and March 2017. DLCFV was diagnosed using radiographic imaging and intraoperative endoscopy. We also conducted a PubMed search and included only original studies related to DLCFV treatment written in English in our review of the literature. Endoscopic third ventriculostomy (ETV) was performed in all patients. Additional endoscope-assisted placement of a fourth ventriculoperitoneal (VP) shunt was performed in two patients who could not be managed with ETV alone because of severe adhesion of the interpeduncular cistern due to subarachnoid hemorrhage (SAH). The patients’ symptoms and the size of the fourth ventricle improved with surgical treatment, without complications. Endoscopic surgery for DLCFV appears to be a safe and effective treatment. Based on our treatment strategy, ETV is the first-line treatment for DLCFV. Endoscope-assisted placement of the fourth VP shunt can be treatment for severe adhesion of the interpeduncular cistern.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment Strategy for a Disproportionately Large Communicating Fourth Ventricle: Case Series and Literature Review

Kawabata

Takeuchi

Nagata

et al. 2020

Neurol. Med. Chir.(Tokyo)

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“…The other option is to create a communication hole to provide flow of liquid between the cyst and the anatomic cisterns. Cystoperitoneal shunting and stereotactic intracavitary irradiation are also among the surgical options [6,7,10,11,16,17]. Arachnoid cyst surgery has some risks.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Fourth Ventricle Arachnoid Cyst Extending to the Upper Border of the Dens of the Axis: A Case Report and Review of the Literature

2014

Maced J Med Sci

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Arachnoid cysts are congenital and non-tumorous intra-arachnoid fluid accumulations that make up about 1% of all intracranial space. occupying lesions. We report a patient with a fourth ventricle arachnoid cyst extending to the upper border of the dens of the axis. This patient progressively developed walking difficulty and stiffness in his legs together with difficulty in grasping objects with his hands within one year. The cyst was totally excised and the patient's symptoms improved in the early postoperative period, but he developed intraventricular and intracisternal air which was followed-up conservatively and resolved spontaneously.

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“…Disproportionately large communicating fourth ventricle (DLCFV) is rare [1]. It was first proposed in 1980 as a subtype of communicating hydrocephalus presenting with a universal enlarged ventricular system including a disproportionately dilated fourth ventricle without history of ventriculo-peritoneal (VP) shunt [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Disproportionately large communicating fourth ventricle: two case reports

Lyu

Wang

et al. 2019

J Med Case Reports

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Background: Management of the disproportionately large communicating fourth ventricle is still problematic. Case presentation: Two cases of disproportionately large communicating fourth ventricle were treated successfully. One was a case of a 51-year-old Han Chinese woman with a complaint of headache and dizziness of 1 year's duration. Magnetic resonance imaging (MRI) demonstrated hydrocephalus with a disproportionately large fourth ventricle. She underwent a ventriculo-peritoneal shunt of the right lateral ventricle. Her symptoms were relieved totally. Five years later, magnetic resonance imaging showed she had a normal ventricular system. The other case was a 24-year-old Han Chinese man with a 2-month history of headache and dizziness accompanied by progressive loss of bilateral vision. Magnetic resonance imaging revealed hydrocephalus with a disproportionately large fourth ventricle, crowded posterior cranial fossa, and syringomyelia extending from C1 to C5. He underwent suboccipital and C1 decompression and duraplasty. Shortly after the surgery, his symptoms were relieved completely, the syringomyelia completely disappeared, and the fourth ventricle became significantly smaller. Conclusions: The management of the disproportionately large communicating fourth ventricle should be individualized. If it coexists with crowded posterior cranial fossa or syringomyelia, posterior fossa decompression could be an option for initial management. If there is no sign of crowded posterior cranial fossa or syringomyelia, shunt of the lateral ventricles might be the first choice.

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Disproportionately Large Communicating Fourth Ventricle Associated With Syringomyelia and Intradural Arachnoid Cyst in the Spinal Cord Successfully Treated With Additional Shunting

Cited by 8 publications

References 12 publications

Endoscopic Treatment Strategy for a Disproportionately Large Communicating Fourth Ventricle: Case Series and Literature Review

Endoscopic Treatment Strategy for a Disproportionately Large Communicating Fourth Ventricle: Case Series and Literature Review

Symptomatic Fourth Ventricle Arachnoid Cyst Extending to the Upper Border of the Dens of the Axis: A Case Report and Review of the Literature

Disproportionately large communicating fourth ventricle: two case reports

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