Hydrocephalus due to membranous obstruction of the fourth ventricle

Abstract

✓ Four patients with hydrocephalus due to membranous obstruction of the fourth ventricle are presented. This rare entity produced radiographic and clinical findings suggestive of posterior fossa tumor. Operative findings included normal cerebellar development and a translucent membrane just above the foramen of Magendie. Etiological possibilities are discussed.

Long-term results of fourth ventriculo-cisternostomy in complex versus simplex atresias of the fourth ventricle outlets

“…In a careful search of the literature, I was able to find only a very limited number of paper's dealing with similar direct surgery. Amacher and Page [2] reported 4 cases of membranous obstruction of the fourth ventricle similar to our observations. In the initial 3, they simply opened the membranous lesion followed by early recurrence leading to death in 2, while the third case i ~/0 a w. x. Chai: Fourth Ventriculo-Cisternostomy in Complex Versus Simplex Atresias received a ventriculo-peritoneal(V-P) shunt subsequently.…”

“…In other cases, also 3 in this series, the pathogenesis of the foraminal adhesion might be suspected as the result of an infective (probably viral) meningo-encephalitis which may have been subclinical. In the majority of cases, half of the total number in this series, however, the key pathological finding has been known to be a typical semitransparent membranous occlusion of the out-lets of the fourth ventricle [2,3,12]. Convincing data concerning the pathogenesis of the membrane in question have been lacking in the literature.…”

“…The patient so treated did well at the time of their publication one year after operation [2] but long-term results have not been published. Most authors [1,2,4,6,7,[10][11][12][13][14][15]20] seem to have been content to do V-P or ventriculo-atrial(V-A) shunt for hydrocephalics as the operation of choice in general and for DLCFV in particular, especially when basal cisternal obstruction coexists [2]. With this predilection in the mind of neurosurgeons, it is understandable why the 4TH V-C operation reported has not met with wider acceptance.…”

Diverticular enlargement of the foramina of Luschka and congenital hydrocephalus

“…However, the radiographic findings of digital impressions and osteolytic changes in the dorsum sellae indicated long-standing, presumably congenital, hydrocephalus. FVOO, a rare but recognized cause of hydrocephalus [1,15,20,21,22,23], was diagnosed in our patient by CT cisternography.…”

“…Congenital fourth ventricular outlet obstruction (FVOO) is a rare cause of hydrocephalus [1,22]. FVOOs occur primarily in children and are the subject of many reports on Dandy-Walker cyst, which is characterized by atresia of the foramina of Luschka and Magendie and hypoplasia or absence of the cerebellar vermis [21].…”