Obstruction Of Aqueduct Research Articles

Postulating the concept of compensated trapped fourth ventricle: a case-based demonstration with long-term clinicoradiological follow-up

A trapped fourth ventricle (TFV) is diagnosed when the inlet and outlets of the fourth ventricle are obstructed with a resultant dilated fourth ventricle. A 3-month-old male child had a ventriculoperitoneal shunt for post-infectious hydrocephalus. At the age of 9 years, he became symptomatic with altered sensorium. He had a CT head which showed enlarged ventricles with a large fourth ventricle. A subsequent ventriculogram revealed dilated lateral ventricles with an aqueductal obstruction in association with an enlarged fourth ventricle. Although diagnosed as a TFV radiologically, his lateral ventricle shunt was revised with a diagnosis of shunt malfunction as there was a simultaneous dilatation of the lateral ventricle. He was never treated for the TFV. At his latest follow-up at 25 years of age, his MRI brain showed well-decompressed lateral ventricles with a large fourth ventricle. On clinical examination, he had truncal ataxia noticed only during turning which, according to the mother, "was always there". His MR flow study showed obstruction at the level of the aqueduct with some evidence of bidirectional flow at the foramen of Magendie. The concept of compensated hydrocephalus represents a stage where a previously active hydrocephalus attains a nonprogressive state clinically and radiologically. We postulate the concept of a "compensated" TFV with a long-term clinical and radiological follow-up. We demonstrate and describe a compensated TFV and reiterate that a TFV is a functional concept with imaging being at most only corroboratory.

Value of cine phase contrast magnetic resonance imaging to predict obstructive hydrocephalus.

This is a prospective study to evaluate the role of CINE MRI to predict obstructive hydrocephalus in the preoperative work-up. A total of 16 patients with aqueductal obstruction demonstrated by CINE MRI who were undergoing ETV were included. MRI was performed preoperatively, at 3 months, at 12 months and at 24 months after surgery. Prior to the fenestration of the third ventricular floor aqueductal patency was evaluated using intraoperative ventriculography. A successful outcome was defined by using radiological and clinical criteria. In 8 patients with aqueductal obstruction on preoperative CINE MRI aqueductal patency was proven intraoperatively. ETV failed in all patients with intraoperatively proven aqueductal patency. Out of these 8 patients, 1 patient had no risk factors for ETV failure, 3 had 1 risk factor, 3 had 2 risk factors, and 1 had 3 risk factors. Most of the failure (6 out of 8 patients) occurred within 8 weeks of the initial procedure. A lumbar puncture was performed in these patients to avoid misinterpretation of the clinical course. The present study demonstrates that cine phase constrast MR may be a poorer choice to determine aqueductal patency compared to high resolution structural imaging. Interestingly, intraoperative ventriculography was an adjunct to better predict outcome after ETV in patients with obstructive hydrocephalus. In cases with non-conclusive preoperative imaging, postoperative decision making may be supported by the use of intraoperative ventriculography with the goal of reducing unnecessary tests and procedures. However, the analysis of the study data has to be considered as explorative. Therefore, findings should be validated with a larger patient population.

Hydrocephalus in an American Miniature Horse Foal: A Case Report and Review

A 6-year-old multiparous American Miniature Horse mare was presented at 324 days of gestation for evaluation of vaginal bleeding. A manual obstetrical examination was performed and the cervix was found to be open with the fetus in transverse position. The mare was sedated and placed under general anesthesia. Attempts made to mutate the fetus were unsuccessful. A cesarean section was performed and the foal was noted to be in transverse position with marked enlargement of the cranium. The abdominal incision was closed in a routine manner, and the mare recovered from anesthesia without incident. Postoperative treatment consisted of flunixin meglumine, gentamicin sulfate, potassium penicillin, oxytocin, and intravenous fluid therapy. The mare was discharged to the owners 4 days after surgery. A lateral radiograph of the fetus was obtained and confirmed hydrocephalus. On necropsy, it was found that the calvarium measured 59 cm in circumference and was dome-shaped, the neuropil and leptomininges measured only 1 to 2 mm in thickness, the brainstem and cerebellum were reduced in size, and there was moderate distension of the third ventricle with stenosis of the mesencephalic aqueduct. Inflammatory and neoplastic causes of mesencephalic aqueductal obstruction were ruled out by histopatholgy. This represents a classic case of hydrocephalus because of stenosis of the mesencephalic aqueduct, which to our knowledge has not been previously reported in a miniature foal. Further investigation is warranted into the pathogenesis of mesencephalic aqueduct stenosis in foals, which has now been reported in several equine breeds.

Application of phase - contrast cine magnetic resonance imaging (MRI) in endoscopic aqueductoplasty

Objective To evaluate the application of phase-contrast cine magnetic resonance imaging (MRI) in endoscopic aqueductoplasty for patients with obstructive hydrocephalus.Methods The clinical diagnosis of hydrocephalus due to aqueduct obstruction in 23 patients was confirmed by phase -contrast cine MRI examination.The patients were treated with endoscopic aqueductoplasty.MRI was repeated during follow- up period.The cerebrospinal fluid (CSF) flow velocity in aqueduct was measured to determine whether the aqueduct was obstructed.Results The Results of phase - contrast cine MRI examinations indicated that there was no CSF flow in aqueduct in any patient.Aqueductoplasty was successfully performed in all patients.after one week,the Results of phase - contrast cine MRI examinations showed an average CSF flow velocity of ( 4.74 ± 1.77 ) cm/s.During follow - up period,intracranial hypertension recurred in two patients in whom CSF flow was not seen inside the aqueduct by phase - contrast cine MRI scan and the aqueduct re - occlusion was revealed by endoscopic exploration.Conclusions By measuring CSF flow velocity,phase - contrast cine MRI could accurately identify whether the aqueduct is obstructed.It should play an important role in the diagnosis of obstructive hydrocephalus and evaluation of the effectiveness of aqueductoplasty,and it could be used for follow -up evaluation as well. Key words: Neuroendoscope ; Hydrocephalus ; Aqueductoplasty ; Phase - contrast eine MRI ; Cerebrospinal fluid flow ; Dynamics ;

Giant glioependymal cyst in an infant

The authors report the case of an infant with a giant glioependymal cyst. Although it has been suggested that these cysts originate from the tela choroidea, their origin remains controversial. This 35-month-old girl with truncal ataxia was referred to the authors' hospital. Magnetic resonance imaging revealed a giant cystic mass extending from the anterior to the posterior cranial fossa. Hydrocephalus was caused by obstruction of the sylvian aqueduct. Endoscopic fenestration of the cyst wall was performed. Histochemical and immunohistochemical staining identified the lesion as a glioependymal cyst. Magnetic resonance imaging performed 8 months later suggested that the cyst originated from the tela choroidea. At 5-year follow-up, there was no tumor recurrence and she had fully recovered. The origin of glioependymal cysts is discussed, and the authors suggest that their origin is the tela choroidea.

A Pitfall of Neuroendoscopic Intraventricular Hematoma Removal - Delayed Obstructive Hydrocephalus Caused by a Small Remnant Clot -Case Report-

A 57-year-old female presented with a left putaminal hemorrhage, intraventricular hematoma (IVH), and acute obstructive hydrocephalus. Neuroendoscopic surgery was performed for the IVH. Three days after successful IVH removal and improvement of her consciousness, the patient lapsed into a comatose state due to hydrocephalus caused by obstruction of the mesencephalic aqueduct by a small remnant clot. The small clot was identified by constructive interference with steady state magnetic resonance imaging and was removed during a second-look operation. Even after the cerebrospinal fluid circulation improves following neuroendoscopic surgery for IVH, the patient may nevertheless develop a life-threatening condition without warning signs in the subacute phase. Awareness of this complication will lead to early diagnosis and correct management.

Endoscopic treatment of ventriculomegaly hydrocephalus caused by primary or secondary aqueduct obstruction

Objective To explore the indications of surgical treatment of ventriculomegaly hydrocephalus caused by primary or secondary aqueduct obstruction and the prevention of complications. Method Endoscopic treatment of 32 cases of overt ventriculomegaly patients in total, 25 cases were subject to transfrontal -approach endoscopic third ventriculostomy, 1 case was subject to SCC cyst fistulation, 5 cases was subject to suboccipital - approach endoscopic skull cranial fossa cyst resection and cyst - cistema magnafistulation and 1 case was subject to suboccipital approach hydrocephalus plasty. Results After 1-4 years of follow - up, among 32 cases of patients of unstable walking, urinary incontinence, decreased intelligence quotient, psychomotor retardation, the symptoms of 26 cases were significantly improved and the symptoms of 6 cases of patients showed no continuous progression. The post - surgical symptoms of the six cases of patients with preoperative high intracranial pressure symptoms were improved. Conclusions The magnetic resonance imaging test shows the aqueduct stenosis or obstruction is a clear indication of patients of overt ventriculomegaly no matter whether there is clinical symptom of intracranial hypertension or not after surgical treatment As long as attentions are paid to the details during the operation process, the improvement of surgical techniques can avoid the occurrence of complications. Key words: Obstructive hydrocephalus; Neuroendoscopy; Cerebral aqueduct, obstructive

Quality of life in obstructive hydrocephalus: endoscopic third ventriculostomy compared to cerebrospinal fluid shunt

In the current literature, there are essentially no comparisons of quality of life (QOL) outcome after endoscopic third ventriculostomy (ETV) and shunt in childhood hydrocephalus. Our objective was to compare QOL in children with obstructive hydrocephalus, treated with either ETV or shunt. A cross-sectional survey was conducted at SickKids, Toronto of children between ages five and 18 years, with obstructive hydrocephalus due to aqueductal obstruction and no other brain abnormalities. Measures of QOL were the Hydrocephalus Outcome Questionnaire and the Health Utilities Index Mark 3. A subset of patients was given the Wechsler Intelligence Scales for Children (WISC-IV). A total of 47 of 59 (80%) eligible patients participated (24 had ETV as primary treatment, 23 had shunt as primary treatment), with a mean age of 12.1 years (standard deviation 3.9) at assessment. The ETV group was older at initial surgery (p < 0.001) and had larger ventricle size at last follow-up (p = 0.047). In all QOL measures, there were no significant differences between the ETV group and shunt group (all p > or = 0.09). Treatment failure, hydrocephalus complications, and the presence of a functioning ETV at assessment were not associated with QOL differences. Among the 11 children (six ETV, five shunt) who were given the WISC-IV, there were no significant differences between the scores of the ETV group and shunt group (all p > or = 0.11). This is the first study to provide a meaningful comparison of QOL after ETV and shunt in children. These preliminary results suggest that there is no obvious difference in QOL after ETV and shunt.

Hydrocephalus caused by a venous varix

Introduction Vascular malformations are uncommon causes of aqueductal obstruction. To our concern, only one case of hydrocephalus caused by a venous varix draining an unruptured arteriovenous malformation has been described in the literature. Case report We report the case of a 70-year-old woman presenting with progressive cognitive impairment, gait disturbance and urinary incontinence. Magnetic resonance imaging and magnetic resonance angiography revealed a large venous varix draining an unruptured arteriovenous malformation causing hydrocephalus. Conclusion Although uncommon, it is necessary to consider the presence of a vascular malformation in adults who presented with signs of aqueductal obstruction.

Coexistent intraventricular abnormalities in periventricular giant arachnoid cysts

Arachnoid cysts are congenital lesions that arise during development by splitting of the arachnoid membrane. Large cysts can be adjacent to CSF pathways causing a marked midline shift and hydrocephalus. The association between a large arachnoid cyst and hydrocephalus has been commonly described as being due to a mass effect, but these previous reports have not focused closely on any associated intraventricular abnormalities. Seven patients who were previously treated with a cystoperitoneal shunt presented with shunt failure, hydrocephalus, and/or cyst expansion. All of these patients had giant arachnoid cysts extending to the periventricular region from the original site, which was the sylvian fissure in 4 patients, and the suprasellar cistern, quadrigeminal cistern, and interhemispheric fissure in 1 patient each. Endoscopic exploration of the ventricular system and cyst fenestration was then performed in all patients. The endoscopic findings were obstruction of the cerebral aqueduct by a membrane not related to the cyst in 5 patients, occlusion of the foramen of Monro in 6, septum pellucidum hypoplasia in 2, and occlusion of the cerebral aqueduct by a quadrigeminal arachnoid cyst in 1. Endoscopic procedures performed were septum pellucidum fenestration and/or foraminoplasty in 5 patients, aqueductoplasty in 2, endoscopic third ventriculostomy in 5, fenestration of the lamina terminalis in 1, and direct cystocisternostomy in 1. After the endoscopic procedure, signs and symptoms of increased intracranial pressure and hydrocephalus improved in all patients, with a reduction in size of the cyst and the ventricle. Ventricular abnormalities contributing to hydrocephalus may be associated with arachnoid cysts. These abnormalities may more likely reflect a common origin than a casual relation. Foramen of Monro stenosis and cerebral aqueduct occlusion associated with an arachnoid cyst can be more frequent than has been previously believed. In cases of periventricular giant arachnoid cysts, endoscopic exploration is a good alternative for examining the ventricular system and identifying and treating CSF obstructions caused by and/or related to arachnoid cysts.

Endoscopic aqueductoplasty in the treatment of aqueductal obstructive hydrocephalus

Objective To study the application of endoscopic aqueductoplasty for the treatment of aqueductal obstructive hydrocephalus. Methods 16 cases of aqueductal obstructive hydrocephalus were treated with endoscopic aqueductoplasty under flexible neuron-endoscope in trans-frontal or stiboccipital approach respectively from Febrary 2007 to April 2008. Results All 16 patients had a sucessful aqueductoplasty with no complications related to aqueductoplasty such as disturbance of consciousness or oculomotor nerve paresis. The symptom of intracranial hypertension disappeared postoperatively. The maximal velocity of cerebrospinal fluid flow through aqueduct increased (2.18±0.34) cm/s and the maximal flux increased (0. 22±0. 07) ml/s detected by using cine phase-contrast magnetic resonance imaging 6 months postoperation in 12 cases. Conclusion Endoscopic aqueductoplasty with flexible neuron-endoscope is a safe and effective method for the treatment of obstructive hydrocephalus due to aqueductal stenosis or aqueductal membranous obstruction, but the operative indication should be obeyed strictly. Key words: Neuron-endoscope; Obstructive hydrocephalus; Aqueductal stenosis; Aqueductal membranous obstruction; Aqueductoplasty

New experimental model of acute aqueductal blockage in cats: Effects on cerebrospinal fluid pressure and the size of brain ventricles

It is generally assumed that cerebrospinal fluid (CSF) is secreted in the brain ventricles, and so after an acute blockage of the aqueduct of Sylvius an increase in the ventricular CSF pressure and dilation of isolated ventricles may be expected. We have tested this hypothesis in cats. After blocking the aqueduct, we measured the CSF pressure in both isolated ventricles and the cisterna magna, and performed radiographic monitoring of the cross-sectional area of the lateral ventricle. The complete aqueductal blockage was achieved by implanting a plastic cannula into the aqueduct of Sylvius through a small tunnel in the vermis of the cerebellum in the chloralose-anesthetized cats. After the reconstitution of the occipital bone, the CSF pressure was measured in the isolated ventricles via a plastic cannula implanted in the aqueduct of Sylvius and in the cisterna magna via a stainless steel cannula. During the following 2 h, the CSF pressures in the isolated ventricles and cisterna magna were identical to those in control conditions. We also monitored the ventricular cross-sectional area by means of radiography for 2 h after the aqueductal blockage and failed to observe any significant changes. When mock CSF was infused into isolated ventricles to imitate the CSF secretion, the gradient of pressure between the ventricle and cisterna magna developed, and disappeared as soon as the infusion was terminated. However, when mock CSF was infused into the cisterna magna at various rates, the resulting increased subarachnoid CSF pressure was accurately transmitted across the brain parenchyma into the CSF of isolated ventricles. The lack of the increase in the CSF pressure and ventricular dilation during 2 h of aqueductal blockage suggests that aqueductal obstruction by itself does not lead to development of hypertensive acute hydrocephalus in cats.

Acute post-traumatic hydrocephalus in an infant due to aqueductal obstruction by a blood clot: a case report

Acute post-traumatic hydrocephalus (PTH) in an infant with mild head injury is a rare entity. We report in this paper an 11-month-old baby who presented with acute PTH secondary to aqueductal obstruction by an intraventricular blood clot. The child recovered completely following a ventriculo-peritoneal shunt. Acute hydrocephalus may develop secondary to aqueductal obstruction by a blood clot in children with even mild head injury.

Sporadic obstructive hydrocephalus in Aqp4 null mice

Aquaporin-4 (Aqp4) is a water transport protein expressed in glia and ependymocytes in brain. We report here the unexpected occurrence of severe obstructive hydrocephalus in a random subset of Aqp4 knockout mice. Of 612 Aqp4 knockout mice produced by heterozygote-heterozygote or knockout-knockout breedings, 9.6% of offspring manifested progressive encephalomegaly. Encephalomegaly was never seen in wild-type or Aqp4 heterozygous mice. Examination of the subset encephalomegalic mice revealed marked triventricular hydrocephalus (lateral ventricle size approximately 500 mm(3)), elevated intracranial pressure (19 +/- 3 vs. 6.1 +/- 0.6 mm Hg), and death by age 6 weeks, with a median survival of 28 days. Intraventricular dye injection studies revealed total obstruction of the cerebral aqueduct. Evans blue extravasation studies indicated an intact blood-brain barrier in the hydrocephalic mice. Brain histology revealed reduced ventricular size and ependymocyte disorganization in some nonhydrocephalic Aqp4 null mice. Our studies establish Aqp4 deletion as a predisposing factor for the development of congenital obstructive hydrocephalus in mice. We suggest that AQP4 polymorphisms might also contribute to the development of aqueduct stenosis in humans.

Phase-Contrast MR Imaging Support for the Diagnosis of Aqueductal Stenosis

Patients with aqueductal stenosis (AS) present with various clinical and radiologic features. Conventional MR imaging provides useful information in AS but depends on a subjective evaluation by the neuroradiologist. The purpose of this study was to evaluate the support of the phase-contrast MR imaging (PC-MR imaging) technique (sensitive to CSF flows) for the diagnosis of AS. We retrospectively considered 17 patients who underwent PC-MR imaging to explore hydrocephalus, with the absence of CSF flow at the aqueductal level. We analyzed their clinical and morphologic MR imaging data. None of the usually reported direct or indirect signs of aqueductal obstruction were seen in 7 patients in whom the clinical suggestion of AS was confirmed by PC-MR imaging results. Seven patients in this population had a third ventriculostomy, and 5 of them were among those in whom conventional MR imaging failed to reveal signs of aqueductal obstruction. All of these 7 patients had a positive postsurgical outcomes. The analysis of CSF and vascular dynamic data in this population was compared with an aged-matched population, and these data were found similar except for the fourth ventricular CSF flush flow latency. PC-MR imaging supports the diagnosis of CSF flow blockage at the aqueductal level in a reliable, reproducible, and rapid way, which aids in the diagnosis of AS in patients with clinical and/or radiologic suggestion of obstructive hydrocephalus. We, therefore, suggest using this technique in the current evaluation of hydrocephalus.

O.131 Detection of occult shunt dependency with computerized overnight monitoring in children

To evaluate the role of three-dimensional constructive interference in steady state (3D-CISS) sequences and phase-contrast magnetic resonance imaging (PC-MRI) in patients with arrested hydrocephalus.A prospective study of 20 patients with arrested hydrocephalus was carried out. All patients underwent PC-MRI and 3D-CISS for assessment of the aqueduct. Axial (through-plane), sagittal (in-plane) PC-MRI, and sagittal 3D-CISS were applied to assess the cerebral aqueduct and the spontaneous third ventriculostomy if present. Aqueductal patency was graded using 3D-CISS and PC-MRI. Quantitative analysis of flow through the aqueduct was performed using PC-MRI.The causes of obstruction were aqueductal obstruction in 75% (n = 15), third ventricular obstruction in 5% (n = 1), and fourth ventricular obstruction in 20% (n = 4). The cause of arrest of hydrocephalus was spontaneous third ventriculostomy in 65% (n = 13), endoscopic third ventriculostomy in 10% (n = 2), and ventriculoperitoneal shunt in 5% (n = 1), and no cause could be detected in 20% of patients (n = 4). There is a positive correlation (r = 0.80) and moderate agreement (κ = 0.509) of grading with PC-MRI and 3D-CISS sequences. The mean peak systolic velocity of cerebrospinal fluid was 1.86 ± 2.48 cm/second, the stroke volume was 6.43 ± 13.81 μL/cycle, and the mean flow was 0.21 ± 0.32 mL/minute.We concluded that 3D-CISS and PC-MRI are noninvasive sequences for diagnosis of the level and cause of arrested hydrocephalus.

O.013 Mathematical modelling of acqueductal CSF flow

To evaluate the role of three-dimensional constructive interference in steady state (3D-CISS) sequences and phase-contrast magnetic resonance imaging (PC-MRI) in patients with arrested hydrocephalus.A prospective study of 20 patients with arrested hydrocephalus was carried out. All patients underwent PC-MRI and 3D-CISS for assessment of the aqueduct. Axial (through-plane), sagittal (in-plane) PC-MRI, and sagittal 3D-CISS were applied to assess the cerebral aqueduct and the spontaneous third ventriculostomy if present. Aqueductal patency was graded using 3D-CISS and PC-MRI. Quantitative analysis of flow through the aqueduct was performed using PC-MRI.The causes of obstruction were aqueductal obstruction in 75% (n = 15), third ventricular obstruction in 5% (n = 1), and fourth ventricular obstruction in 20% (n = 4). The cause of arrest of hydrocephalus was spontaneous third ventriculostomy in 65% (n = 13), endoscopic third ventriculostomy in 10% (n = 2), and ventriculoperitoneal shunt in 5% (n = 1), and no cause could be detected in 20% of patients (n = 4). There is a positive correlation (r = 0.80) and moderate agreement (κ = 0.509) of grading with PC-MRI and 3D-CISS sequences. The mean peak systolic velocity of cerebrospinal fluid was 1.86 ± 2.48 cm/second, the stroke volume was 6.43 ± 13.81 μL/cycle, and the mean flow was 0.21 ± 0.32 mL/minute.We concluded that 3D-CISS and PC-MRI are noninvasive sequences for diagnosis of the level and cause of arrested hydrocephalus.

O.033 CSF and blood flows alterations in cerebral venous thrombosis

To evaluate the role of three-dimensional constructive interference in steady state (3D-CISS) sequences and phase-contrast magnetic resonance imaging (PC-MRI) in patients with arrested hydrocephalus.A prospective study of 20 patients with arrested hydrocephalus was carried out. All patients underwent PC-MRI and 3D-CISS for assessment of the aqueduct. Axial (through-plane), sagittal (in-plane) PC-MRI, and sagittal 3D-CISS were applied to assess the cerebral aqueduct and the spontaneous third ventriculostomy if present. Aqueductal patency was graded using 3D-CISS and PC-MRI. Quantitative analysis of flow through the aqueduct was performed using PC-MRI.The causes of obstruction were aqueductal obstruction in 75% (n = 15), third ventricular obstruction in 5% (n = 1), and fourth ventricular obstruction in 20% (n = 4). The cause of arrest of hydrocephalus was spontaneous third ventriculostomy in 65% (n = 13), endoscopic third ventriculostomy in 10% (n = 2), and ventriculoperitoneal shunt in 5% (n = 1), and no cause could be detected in 20% of patients (n = 4). There is a positive correlation (r = 0.80) and moderate agreement (κ = 0.509) of grading with PC-MRI and 3D-CISS sequences. The mean peak systolic velocity of cerebrospinal fluid was 1.86 ± 2.48 cm/second, the stroke volume was 6.43 ± 13.81 μL/cycle, and the mean flow was 0.21 ± 0.32 mL/minute.We concluded that 3D-CISS and PC-MRI are noninvasive sequences for diagnosis of the level and cause of arrested hydrocephalus.

VENOUS LESIONS AS A CAUSE OF SYLVIAN AQUEDUCTAL OBSTRUCTION

The cases of two patients who presented with sylvian aqueductal obstruction caused by venous lesions (an ectatic vein and a developmental venous anomaly, which are uncommon causes of obstructive hydrocephalus) are reported. A 42-year-old man presented with chronic headache and behavior abnormalities. Magnetic resonance imaging revealed supratentorial ventricular dilation caused by an obstruction of the sylvian aqueduct by a developmental venous anomaly. An 18-year-old man complained of intermittent headaches. The magnetic resonance imaging scan disclosed aqueductal stenosis-type hydrocephalus secondary to an ectatic vein. Both patients underwent endoscopic third ventriculostomy and recovered well. During the procedures, the aqueductal obstruction by venous elements could be seen clearly. Venous anomalies may cause obstructive hydrocephalus and can be suspected in cases of chronic and intermittent headaches. Endoscopic third ventriculostomy is an effective treatment.

Endoscopic Treatment of Hydrocephalus Due to Aneurysm of the Vein of Galen: Case Report and Literature Review

Aneurysms of the vein of Galen are uncommon vascular malformations. They are most frequently seen in infants and children, leading to heart failure and hydrocephalus. Exceptionally, they are detected in adults. Several theories have been proposed to explain hydrocephalus in these patients: obstruction of the cerebral aqueduct, impaired absorption of CSF after subarachnoid hemorrhage, passive ex-vacuo mechanism, or thrombosis of an aneurysm. Hydrocephalus has been treated mainly with cerebrospinal shunt procedures, but also direct surgery, radiosurgery and embolisation of the malformation have proved to be effective. We report the case of a partially thrombosed ectasia of the vein of Galen in a 44-year-old male, with huge hydrocephalus successfully treated with an endoscopic third ventriculostomy.