Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Abstract

is a rare cause of obstructive hydrocephalus.7) However, a distinct subgroup of patients present with radiological evidence of FVOO, in their adulthood, without any significant underlying etiology.3) It is most often seen associated with an underlying pathology that is responsible for the inflammation and scarring of the outlet foramina; however, there have been a few reports in which no predisposing causes have been identified. Histopathological evaluation of the membrane has revealed neural tissue and gliosis without any active inflammation. 4)The treatment for these malformations is still controversial. Hydrocephalus can be treated with cerebro-spinal fluid (CSF) shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, and endoscopic third ventriculostomy (ETV) or endoscopic fourth ventriculostomy. Materials and MethodsInformed patient consent was obtained for this procedure. All patients' data are summarized in Table 1. A 40-year-old man approached us with complaints of headache and neck pain. The patient's neurological examination was normal. Magnetic resonance imaging (MRI) revealed tetraventricular hydrocephalus, dilatation level of aquaductus Sylvii, tonsillar ectopia, and compression to the brain stem and cerebellum, and a membrane causing an obstruction at the level of foramen Magendie. Cervical MRI showed syringomyelia between C1 and C7. Cine-MR revealed no CSF f low through the foramen Magendie and foramen magnum. At the level of aquaductus Sylvii, turbulence, and tertiary flow were observed.Second patient; a 44-year-old woman presented with weakness in bilateral upper extremity. She complained of numbness in the arms, defect in discriminating between hot and cold, and difficulty in swallowing. MRI showed tetraventricular hydrocephalus, tonsillar ectopia, and syringomyelia between C1 and L1. Neurological examination showed left 11th and 12th cranial nerve deficiency, reduced GAG reflex, quadriparesis, hyperactive reflexes, and bilaterally ankle clonus.Third patient; a 33-year-old woman complained of headache. MRI revealed tetraventricular hydrocephalus and Chiari Type I malformation with syringomyelia between C1 and C5. Neurological examination was normal.Fourth patient; a 21-year-old man presented with weakness in the hands and urinary incontinence. MRI demonstrated tetraventricular hydrocephalus, tonsillar ectopia, and syringomyelia between C1 and L1. Neurological examinationWe present four cases of hydrocephalus caused by occlusion of foramen of Magendie associated with Chiari Type I malformation and syringomyelia. The aim of this study is to evaluate the results of surgical treatment via fourth ventriculostomy with catheter from the fourth ventricle to the upper cervical subarachnoid space. Obstructive tetraventricular hydrocephalus due to occlusion of the foramina of Luschka and Magendie can be treated with cerebro-spinal fluid shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, endoscopic third ventriculostomy, and endoscopic four...

Endoscopic third ventriculostomy in the fourth ventricle outlet obstruction associated with chiari malformation Type I and syringomyelia: Case report

“…All four patients had a membrane obstructing the Magendie foramen visible intraoperatively after posterior fossa cerebral decompression and exploration. [12] The treatment of these malformations is still controversial. Different approaches have been described for the treatment of hydrocephalus due to FVOO, such as ventriculoperitoneal shunt, ETV, fourth endoscopic ventriculostomy, suboccipital craniectomy with a simple opening of the obstructing membrane or placement of a catheter to maintain its permeability to the cisterna magna or the subarachnoid space of the anterolateral superior cervical spinal cord.…”

“…Indeed, posterior fossa craniotomy and membrane excision are still advocated by some. [12,17] Orakdogen et al suggest that suboccipital craniectomy with the opening of the obstructing membrane and placement of a catheter is the most physiological approach, restoring the original pathway of CSF circulation. [5,12] However, this technique is far from being minimally invasive.…”

“…[12,17] Orakdogen et al suggest that suboccipital craniectomy with the opening of the obstructing membrane and placement of a catheter is the most physiological approach, restoring the original pathway of CSF circulation. [5,12] However, this technique is far from being minimally invasive. In addition, the ventriculo-subarachnoid shunt is a foreign material that can be responsible for complications such as infection and catheter migration.…”