Normal Cistern Research Articles

Transventricular transforaminal endoscopic fenestration with cysto-ventriculoperitoneal shunt to manage a third ventricular arachnoid cyst: a case report

Regular ventriculoperitoneal (VP) shunt is commonly used as the first option to manage a third ventricular arachnoid cyst due to the lack of facilities, unfamiliarity with endoscopic techniques, or misdiagnosis as purely obstructive hydrocephalus. A 9-year-old girl with obstructive hydrocephalus due to a third ventricular arachnoid cyst was treated with a VP shunt. 2 months later, the previous shunt device was removed due to an infection. Following a sterile cerebrospinal fluid analysis culture, we conducted a navigation-assisted transventricular transforaminal endoscopic fenestration and cysto-VP programmable shunt placement. A decrease in ventricular dilatation was seen on follow-up. This approach was justified due to the possibility of establishing communication with normal cisterns, the high rate of cyst elimination, and the potential for achieving shunt independence. Performing an endoscopic fenestration followed by cysto-VP shunt placement could be an optimal option for managing this condition.

Intrathecal Gadolinium-Enhanced MR Myelography Showing Multiple Dural Leakages in a Patient with Marfan Syndrome

oss of CSF or imbalance of its turnover can cause symptoms such as orthostatic headaches, nausea, and neck pain. These symptoms are frequently the result of CSF leakage from the dura and can occur spontaneously or after trauma, lumbar puncture, or neurosurgery. It has been suggested that disorders of the connective tissues predispose patients to spontaneous CSF leaks [1]. Hence, localization and identification of dural leakages are crucial for satisfactory treatment. We present the case of a patient with Marfan syndrome and multiple dural leaks. The exact site of CSF leakage was not apparent on conventional myelography or high-resolution CT myelography, but was shown using intrathecal contrast-enhanced MR myelography. Case Report A 19-year-old man with Marfan syndrome presented with severe headaches, neck pain, and nausea. These symptoms were triggered by orthostatic conditions involving an erect posture (e.g., sitting, standing, or walking). However, the symptoms resolved after lying down for several minutes. Blood analysis and neurologic examinations presented normal parameters. Intrathecal pressure was not measurable after lumbar puncture. Spontaneous intracranial hypotension (SIH) and chronic loss of CSF were assumed to be responsible for the symptoms. MR images using T1- and T2-weighted and constructive interference in steady-state 3D imaging showed dural ectasia at different levels of the lumbosacral spine and extradural fluid with CSF-like signal performance dorsally to L5 and S1, but no connection to the subarachnoid space was proven. A CT scan of the brain showed normal cisterns, no caudal displacement of the brainstem, and no evidence of low intracranial pressure. Myelography, a postmyelography high-resolution CT scan, and T2

Controversies in the management of spontaneous cerebellar haemorrhage. A consecutive series of 49 cases and review of the literature.

We have reviewed our experience with a series of 49 consecutive patients with spontaneous cerebellar haematoma, treated according to a standardized management protocol. Seventeen patients were managed conservatively, 30 underwent ventricular drainage, and in six patients the haematoma was evacuated. The indications for the different modes of treatment are discussed. The most significant prognostic factors determining the outcome at one month were the grade of quadrigeminal cistern obliteration on the initial CT scan and the Glasgow Coma Scale on admission. Patients with normal cisterns had a good outcome, and only needed (temporary) ventricular drainage in case of hydrocephalus. Patients with totally obliterated cisterns had a bad outcome irrespective of treatment. In the patients with compressed cisterns, it is suggested that evacuation of the haematoma might improve outcome; treatment of hydrocephalus alone is insufficient in many cases in this group.

Computed Tomography of the Cerebellopontine Cistern in Normal and Acoustic Tumor Patients

Air computed tomography of the cerebellopontine cistern was performed in 15 consecutive patients. The series comprised 7 patients with a normal cistern and 8 patients with tumor, including one with bilateral tumors. Two tumors were of small size (less than 10 mm i diameter), 3 were medium sized (10-20 mm in diameter), and 4 were large (greater than 20 mm in diameter). In the normal group, the jugular foramen nerve bundle (the 9th, 10th and 11th nerves), the trigeminal nerve, or the brain stem margin were clearly defined by air. In the tumor group, the possible extension of the tumor to these structures could be defined. Differentiation between a compression or attachment of the trigeminal nerve to the tumor was not always possible. The importance of using reconstruction views is stressed.

ABSENT OR COMPRESSED BASAL CISTERNS ON FIRST CT SCAN

The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p less than 0.001). The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.

Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury.

The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p less than 0.001). The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.