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At least 19 recordsLinked to original sources
PubMed1991

[A case of disproportionately large communicating fourth ventricle after resection of temporal astrocytoma that evolved an isolated fourth ventricle].

The isolation and enlargement of the fourth ventricle after a ventriculoperitoneal (V-P) shunt was classified as "isolated fourth ventricle (IFV)". The term, "disproportionately large communicating fourth ventricle (DFV)" was first introduced by Scotti et al as being an enlarged fourth ventricle communicating with the third ventricle. The authors present a case of DFV after the resection of an astrocytoma. Upon recurrence of the tumor a second resection was carried out 5 years later. It was found that IFV had evolved because a cyst in the right temporal lobe was obstructing the aqueduct. After shunting of the tumor cyst, the aqueduct was again found to be patent and the fourth ventricle gradually decreased in size. A 34-year-old female presented headache, nausea, and a mild left hemiparesis. An initial CT scan demonstrated a fourth ventricle of approximately normal size and a right temporal mass. The first craniotomy revealed an astrocytoma. A CT scan after the surgical procedure showed enlargement of all ventricles, especially the fourth, resulting from the blockage of the foramina of Luschka and Magendie. The insertion of a V-P shunt was followed by a reduction in size of all ventricles. The diagnosis of DFV was thus confirmed because the fourth ventricle had a demonstrated communication with the third ventricle. After a second craniotomy for tumor recurrence five years later, a CT scan revealed the enlargement of the fourth ventricle and a cyst in the right temporal lobe. A metrizamide CT scan revealed that the cyst was isolated and an RI ventriculogram confirmed obstruction of the aqueduct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Trapped fourth ventricle treated with shunt placement in the fourth ventricle by direct visualization with flexible neuroendoscope.

Shunt placement was the most common procedure used for ventricular dilatation, but in many neurosurgical centers it has been substituted by flexible neuroendoscope; however, none of them had solved the problem of the trapped and dilated fourth ventricle. The combination of the ventricle-peritoneal catheter placement in the center of the fourth ventricle by direct visualization with a flexible neuroendoscope using a single coronal burr-hole has solved this problem. Eleven patients with a trapped fourth ventricle, with previous third ventriculostomy and aqueductal plasty, were treated with this procedure; all patients were evaluated clinically and with computed tomography 8 to 24 months (mean, 18 months) later. Here, we describe the technical procedure.

Adolescent↗
PubMed2006

Etiological differences between the isolated lateral ventricle and the isolated fourth ventricle.

OBJECTIVE: To determine if an etiological difference exists between isolation of the lateral ventricle and isolation of the fourth ventricle after ventricular shunting. METHODS: Cases of symptomatic isolation of the lateral and fourth ventricles were reviewed retrospectively. The ages at presentation of ventricular isolation, the time course to development of isolation, the number of shunt surgeries leading up to symptomatic isolation, the types of shunt valves utilized, and the background of infection were analyzed. RESULTS: Twenty-six patients had lateral ventricle isolation and 11 patients had fourth ventricle isolation. Infection, hemorrhage, Chiari malformation/myelomeningocele, and aqueductal stenosis were factors contributing to hydrocephalus requiring treatment in these patients. Compared to 26.9% of patients with lateral ventricle isolation, 90.9% of patients with fourth ventricle isolation had a previous history of infection. CONCLUSIONS: Prior meningitis and ventriculitis frequently contributed to fourth ventricle isolation. Lateral ventricle isolation seems to arise from functional obstruction of the foramen of Monro related to prior shunting.

Adolescent↗
PubMed1993

Dilated fourth ventricle in Arnold-Chiari malformation type II: isolated fourth ventricle as sequelae of shunt?--Case report.

A female infant with Arnold-Chiari malformation type II developed cystic dilatation of the fourth ventricle at age 15 months. She received shunt emplacement into the dilated fourth ventricle to restore communication to the subarachnoid space and achieved improved symptoms and decreased ventricular size. Such dilatation is a typical feature of this malformation, and the isolation of the fourth ventricle is supposed to result from the cerebrospinal fluid shunting procedure. In this patient, the cause appeared to be external compression of the aqueduct by the beaking deformity of the mesencephalic spur, a characteristic of Arnold-Chiari malformation type II.

Arnold-Chiari Malformation↗
PubMed2002

In vivo infusions of exogenous growth factors into the fourth ventricle of the adult mouse brain increase the proliferation of neural progenitors around the fourth ventricle and the central canal of the spinal cord.

Stem cells isolated from the fourth ventricle and spinal cord form neurospheres in vitro in response to basic fibroblast growth factor (FGF2)+heparin (H) or epidermal growth factor (EGF)+FGF2 together. To determine whether these growth factor conditions are sufficient to induce stem cells within the fourth ventricle and spinal cord to proliferate and expand their progeny in vivo, we infused EGF and FGF2, alone or together, with or without H, into the fourth ventricle for 6 days via osmotic minipumps. Animals were injected with bromodeoxyuridine (BrdU) on days 4, 5 and 6 of infusion in order to label cells proliferating in response to the growth factors. Infusions of EGF+FGF2+H into the fourth ventricle resulted in the largest proliferative effect, a 10.8-fold increase in the number of BrdU+ cells around the fourth ventricle, and a 33.5-fold increase in the number of BrdU+ cells around the central canal of the spinal cord, as compared to vehicle infused controls. The majority of the cells were nestin+ after 6 days of infusion. Seven weeks post-infusion, 22 and 30% of the number of BrdU+ cells induced to proliferate after 6 days of EGF+FGF2+H infusions were still detected around the fourth ventricle and central canal of the spinal cord, respectively. Analysis of the fates of the remaining cells showed that a small percentage of BrdU+ cells around the fourth ventricle and in the white matter of the spinal cord differentiated into astrocytes and oligodendrocytes. BrdU+ neurons were not found in the brainstem or in the grey matter of the cervical spinal cord 7 weeks post-infusion. These results show that endogenous stem cells and progenitors around the fourth ventricle and central canal of the spinal cord proliferate in response to exogenously applied growth factors, but unlike in the lateral ventricle where they generate some new neurons, they only produce new astrocytes and oligodendrocytes at 7 weeks post-infusion.

Animals↗
PubMed1978

Computed tomography of the trapped fourth ventricle.

A dilated fourth ventricle due to outlet obstruction is a clinical-radiologic entity with symptoms similar to those of a posterior fossa space-occupying lesion. Computed tomography reveals cystic dilatation of the fourth ventricle and hydrocephalus supratentorially. Frequently the symptoms resolve completely and the fourth ventricle returns to normal following lateral ventricular shunting. If there is actual obliteration of the aqueduct, the fourth ventricle must be shunted directly. While the exact mechanism by which the fourth ventricle becomes trapped is not fully known, outlet obstruction must be present. It is most frequently related to previous episodes of meningitis or subarachnoid hemorrhage. In a review of 48 cases of an abnormally enlarged fourth ventricle demonstrated on CT, six were found to have a trapped fourth ventricle. Careful attention to densities and configurations on CT allows its differentiation from other lesions such as cystic tumors and cysts.

Aged↗
PubMed2001

CT stereotaxy guided lateral trans-cerebellar programmable fourth ventriculo-peritoneal shunting for symptomatic trapped fourth ventricle.

A trapped fourth ventricle is a rare clinico-radiological entity producing symptoms suggestive of a progressive posterior fossa mass lesion. It is mainly reported in children as a late complication of lateral ventricular shunting to relieve infantile post-meningitic or post-hemorrhagic hydrocephalus. Optional treatment of the trapped fourth ventricle remains controversial. Placement of fourth ventricular shunting via a conventional midline approach can be fraught with complications in about 40% of the patients. Authors report a successful CT Stereotaxy guided high pressure (80 mm H(2)O) programmable fourth ventriculo-peritoneal shunting via a lateral trans-cerebellar approach in a 14-year-old girl with a trapped fourth ventricle, which occurred as a late complication of ventriculo-peritoneal shunting in her infancy. Her preoperative symptoms of raised intracranial pressure, bobble-head doll syndrome and bilateral abducens palsies completely improved following the surgery. Lateral trans-cerebellar stereotactic placement of the fourth ventricular catheter and the use of high-pressure (low flow) programmable shunt (to avoid complications associated with over drainage) are beneficial in some patients with trapped fourth ventricle.

Abducens Nerve Diseases↗
PubMed2003

Stereotactically-guided fourth ventriculo-peritoneal shunting for the isolated fourth ventricle.

The isolated fourth ventricle (IFV) develops in which obstruction to the out flow of cerebrospinal fluid from the choroid plexus of the fourth ventricle occurs rostrally and caudally. IFV has been a rare occurrence and is difficult to treat. We had an occasion to admit a 28-year-old female to our hospital due to hydrocephalus: she also had a history of meningitis a year ago. The patient was initially managed by a lateral ventriculo-peritoneal shunting procedure. Six months after the procedure the patient began to suffer from vomiting, nausea, and diplopia. CT and MRI scans demonstrated an isolated fourth ventricle enlargement; and thus, a fourth ventriculo-peritoneal shunting procedure was performed under stereotactic conditions. The authors present a case of an isolated fourth ventricle after lateral ventriculo-peritoneal shunting for hydrocephalus, which was treated with a stereotactically guided fourth ventriculo-peritoneal shunting procedure. The technique of this procedure is described below.

Adult↗
PubMed1999

[A rare case of trapped fourth ventricle: an unique symptom appeared after fourth ventriculo-peritoneal shunting].

We experienced a unique case of trapped fourth ventricle after shunting for post-meningitic hydrocephalus. A five-year-old infant was diagnosed as meningitis shortly after his birth, and secondarily suffered from hydrocephalus. He underwent lateral-ventriculo-peritoneal shunting, fourth-ventriculo-cisterna-magna shunting and so on, but bilateral abducens palsy appeared. The following head CT and MRI revealed "trapped fourth ventricle". Though there are several case reports of trapped fourth ventricle with abducens palsy, most of them followed enlargement of the fourth ventricle; nevertheless in our case, abducens palsy appeared when the fourth ventricle reduced in size and the symptom vanished when it enlarged. We thought that a traction force to the abducens nerve had occurred also in the condition of reduced fourth ventricle size, because there would have been a dense adhesion after meningitis in his subarachnoidal space. We tried to improve his symptom in one way or another by keeping the fourth ventricle in appropriate volume. His abducens palsy was controlled by switching the on-off valve between forth ventricle and peritoneum. We expect that a higher-pressure programmable shunt valve or a lower-flow-regulating shunt system be invented in order to cope with the cases like ours.

Abducens Nerve↗
PubMed2002

Rupture of the lateral ventricle secondary to a fourth ventricle tumour resulting in an indirect nontraumatic cerebrospinal fluid fistula.

We present a rare indirect nontraumatic cerebrospinal fluid (CSF) fistula secondary to a fourth ventricle ependymoma. The fistula resulted from rupture of the left temporal horn, distant from the tumour. The fistula was well demonstrated by MRI. High-resolution CT demonstrated a defect in the roof of the sphenoid sinus, but no leakage of CSF was seen on CT cisternography.

Adult↗
PubMed1978

Angiographic diagnosis of fourth ventricle tumors.

Twelve primary fourth ventricle tumors and 22 medulloblastomas occupying mainly the fourth ventricle were analyzed, with emphasis on the differential diagnosis, vascularity, and some unusual findings. Though both types of tumor often have identical manifestations, the correct diagnosis can be made in most cases by careful evaluation of the posterior inferior cerebellar artery, particularly the choroidal and nodular branches. Unusual findings in primary fourth ventricle tumors mimicking tumors of the pons and medulla oblongata are described, and possible explanations for these findings are discussed. The results of this study underscore the importance of angiotomography in the diagnosis of tumors of the fourth ventricle.

Adult↗
PubMed1985

[Brain stem auditory evoked potentials for assessment of isolated fourth ventricle in three patients].

Isolated fourth ventricle is an untoward but interesting complication caused by the shunt procedure, which has been recognized since the introduction of CT scanning. Auditory brain stem evoked potentials (BAEPs) were recorded in a patient with isolated fourth ventricle for assessment of brain stem function. Case 1. A 9-year-old boy. He had undergone repair of the lumbosacral meningocele at birth, followed by shunting procedures, including repeated shunt revision, for hydrocephalus which subsequently developed. CT scanning on admission revealed typical findings of isolated fourth ventricle, while neurological examination disclosed no abnormalities. BAEPs on admission revealed normal waves both in amplitude and latency. This patient has been doing well without further shunting procedures. Case 2. A 17-year-old male was admitted with complaints of headache, diplopia, nystagmus and ataxic gait. He had a history of operation for radical removal of cerebellar astrocytoma and lateral ventriculo-peritoneal shunt at 9 years of age. CT scanning on admission revealed a typical isolated fourth ventricle, and fourth ventricle-peritoneal shunt was performed. Postoperative serial BAEPs revealed gradual improvement of brain-stem function. Clinically he has been symptom-free thereafter except for slight nystagmus. Case 3. A 2-year-old female suffering from hydrocephalus developed after neonatal intraventricular hemorrhage and ventriculitis. After repeated revision of a lateral ventriculo-peritoneal shunt, she was admitted in semicoma with vomiting and opisthotonic posture. CT study revealed an isolated fourth ventricle and preoperative BAEPs showed marked abnormalities. Although fourth ventricle-peritoneal shunt was performed, no remarkable change in BAEPs was obtained, and neurological deficit of considerable degree persisted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Differential diagnosis between ventriculitis and fourth ventricle cyst in neurocysticercosis.

The fourth ventricle is frequently affected in patients with cysticercosis of the central nervous system, due either to a large cyst occluding the cavity or to granular ependymitis (ventriculitis) as a consequence of diffuse inflammation within the intraventricular and subarachnoid spaces. In some cases, the differential diagnosis between these two forms of neurocysticercosis is difficult to make, even after special radiological procedures. It is important to establish the correct diagnosis, since a surgical approach is beneficial only when the fourth ventricle is obstructed by a large cyst. In this paper, the clinical differences between fourth ventricle cysts and ventriculitis are presented in 16 patients with neurocysticercosis who were subjected to surgical exploration of the posterior fossa. Patients with a large cyst occluding the fourth ventricle had a short evolution of signs and symptoms, Bruns' syndrome, and discrete or no inflammatory reaction in the cerebrospinal fluid (CSF). Patients with ventriculitis generally had a longer duration of signs and symptoms, Parinaud's syndrome, a consistently positive complement fixation test to cysticerci, and more cells and proteins in the CSF. The clinical picture and ancillary studies can give the precise diagnosis in most patients before surgical exploration is performed.

Adolescent↗
PubMed2005

Endoscopic options in the management of isolated fourth ventricles. Case report.

Isolation of the fourth ventricle is occasionally observed after shunt treatment of the lateral ventricles for obstructive panventricular hydrocephalus. Of the various surgical options currently available, placement of shunts in the fourth ventricle has remained as the mainstay of treatment. These shunts are difficult to place, however, and have been associated with higher complication rates. With the advent of neuroendoscopic techniques, the treatment of this condition has shifted from shunt therapy to endoscopic third ventriculostomy (ETV) and aqueductal reconstruction. The authors report on four patients (age range 11-28 years old) who had undergone fourth ventricular shunt placement earlier in childhood to treat panventricular hydrocephalus and who presented with an isolated fourth ventricle (IFV) during the follow-up period. All patients underwent magnetic resonance imaging to identify the extent of the stenosed aqueduct. Symptoms improved in all and the size of the fourth ventricle decreased as well, indicating a functioning stent. The ETV failed in two patients, however, and they required placement of a ventriculoperitoneal (VP) shunt. Aqueductal stenting with an ETV or a VP shunt is a promising option in the management of IFVs.

Adult↗
PubMed2000

Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement. Case report.

Isolated fourth ventricle (IFV) is a rare complication in patients who undergo shunt placement, and it is not easily corrected by surgical procedures. The authors report a case of IFV that was successfully treated with an aqueductal stent placed under direct visualization by using a neuroendoscope. This 36-year-old suffered meningitis after partial resection of a brainstem pilocytic astrocytoma, and subsequently developed hydrocephalus for which a ventriculoperitoneal shunt was placed. Nine months later, the patient presented with progressive cerebellar ataxia, and magnetic resonance imaging revealed slitlike supratentorial ventricles and a markedly enlarged fourth ventricle, which were compatible with the diagnosis of IFV. The surgical procedure described was performed under visualization through a styletlike slim optic fiberscope inserted into a ventricular catheter. The catheter, with the endoscope inside it, was passed through the foramen of Monro and then through the aqueduct to reach the enlarged fourth ventricle, where membranous occlusion of the foramen of Magendie was clearly visualized. The tip of the catheter was placed in the fastigium of the fourth ventricle. After the procedure, the size of the fourth ventricle was reduced and the patient's symptoms improved. Thus, it is concluded that endoscopic aqueductal stent placement is a simple and safe surgical procedure for treatment of IFV.

Adult↗
PubMed1989

Osteoblastic meningioma of the fourth ventricle.

Meningiomas of the fourth ventricle are rare neoplasms. Only meningothelial and fibroblastic subtypes, purportedly arising from the tela choroidea, have been described. In this report we describe clinical, neuroradiological and pathological findings in a 52-year-old man with mild hydrocephalus produced by a large, calcified, osteoblastic meningioma of the fourth ventricle.

Cerebral Ventricles↗