Membranous Obstruction of the Fourth Ventricle Outlet

Abstract

We report the case of a 15-year-old girl with amenorrhea and a several-week history of headache. After the diagnosis of membranous obstruction of the foramen of Magendie suggested by MRI, suboccipital craniotomy for removal of the membrane was carried out. The patient made an excellent postoperative recovery, and postoperative phase-contrast MRI demonstrated patent cerebrospinal fluid (CSF) pathways at the level of the foramina of Magendie and Luschka. We believe that this case is of interest because of the unequivocal evidence on MRI studies of the occlusion of the foramen of Magendie preoperatively, and because of the dramatic postoperative MRI findings demonstrating the effectiveness of the surgical procedure both in terms of ventricular size and CSF flow characterization.

Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T

“…Although this assumption seems to be against traditional concept, a few case reports have been published with only 1 exit foramen of the fourth ventricle obstructed, causing tetraventricular hydrocephalus and responding to surgery. [23][24][25][26][27][28][29][30][31][32] These results overlap with observation in our large study cohort. The second step was the acquisition of the 3D-CISS sequence to determine whether there was obstructing membrane either within or outside the ventricular system.…”

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

“…The cisterns retard and direct the flow of CSF [21]: ‘Thus the opening of one cistern does not allow the immediate egress of fluid from the adjoining cisterns and collapse of the entire subarachnoid space.’ [21]. There is no clear reason why such small openings cannot be obstructed and lead to a blockage of the CSF whereas all outlets of the 4th ventricle can be blocked [22, 23]. Especially bleedings or inflammations may lead to obstructions of the small cisternal opening; in one of the presented cases, the resection of the ependymoma with minor hemorrhage or inflammation might have been the reason of intracisternal block.…”

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

“…6) However, some authors reported that the cases who performed fourth ventriculostomy did not require the placement of a catheter to maintain its patency. 4,5,10) Posterior fossa craniotomy and membrane excision are still advocated by some. 10,11) Suboccipital craniectomy is an invasive procedure; suboccipital craniectomy with microsurgical exploration of the foramen of Magendie and excision of the obstructing membranes with or without a catheter to maintain the communication between the ventricular cavity and the subarachnoid space is a more physiological approach.…”

“…4,5,10) Posterior fossa craniotomy and membrane excision are still advocated by some. 10,11) Suboccipital craniectomy is an invasive procedure; suboccipital craniectomy with microsurgical exploration of the foramen of Magendie and excision of the obstructing membranes with or without a catheter to maintain the communication between the ventricular cavity and the subarachnoid space is a more physiological approach. 7) Early in 1962, a new modality of fourth ventriculocisternostomy using a polyethylene catheter was described.…”