Ventricle Compression Research Articles

Surgical Evacuation of Spontaneous Cerebellar Hemorrhage: Comparison of Safety and Efficacy of Suboccipital Craniotomy, Stereotactic Aspiration, and Thrombolysis and Endoscopic Surgery

Current surgical therapies for spontaneous intracerebellar hemorrhage (SCH) include suboccipital craniotomy (SC), stereotactic aspiration and thrombolysis (SAT), and endoscopic surgery (ES). Evidence comparing the therapeutic effects of these 3 methods is scarce. The safety and efficacy of SC, SAT, and ES for SCH are still uncertain. 75 patients with SCH who received SC, SAT, or ES were reviewed retrospectively. Baseline parameters before the operation, evacuation rate, perihematoma edema, postoperative complications, and cumulative case fatalities were collected. Also, 12 months after ictus, the long-term functional outcomes in patients with regard to fourth ventricle compression and age were judged, respectively, by the modified Rankin Scale (mRS). The SAT was less effective in evacuating hematoma than were SC and ES. The perihematoma edema on postoperative day 7 and surgical complications were highest in the SC group. The functional outcome represented by mRS was better in the SAT group than in the SC and ES groups for patients with fourth ventricle compression grade 1. For patients with fourth ventricle compression grades 2 and 3, the ES group achieved the best functional outcome. Patients older than 60 years benefited less from SC than from ES and SAT. SAT may be suitable for SCH patients with fourth ventricle compression grade 1, and ES may be suitable for SCH patients with fourth ventricle compression grades 2 and 3. Aged patients benefit less from SC than from SAT and ES.

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases.

Background:Approximately 20–30% of all intracranial metastases are located in the posterior fossa. The clinical evolution hinges on factors such as tumor growth dynamics, local topographic conditions, performance status, and prompt intervention. Fourth ventricle (V4) compression with secondary life-threatening obstructive hydrocephalus remains a major concern, often requiring acute surgical intervention. We have previously reported on the application of adaptive hypofractionated Gamma Knife Radiosurgery in the acute management of critically located metastases, a technique known to us as rapid rescue radiosurgery (3R). We report the results of 3R in the management of posterior fossa lesions and ensuing V4 decompression.Case Descriptions:Four patients with V4 compression due to posterior fossa metastases were treated with 3R by three separate gamma knife radiosurgical sessions (GKRS) over a period of seven days. Mean V4 volume was 1.02 cm3 at GKRS 1, 1.13 cm3 at GKRS 2, and 1.12 cm3 at GKRS 3. Mean tumor volume during the week of treatment was 10 cm3 at both GKRS 1 and 2 and 9 cm3 at GKRS 3. On average, we achieved a tumor volume reduction of 52% and a V4 size increase of 64% at the first follow-up (4 weeks after GKRS 3). Long-term follow-up showed continued local tumor control, stable V4 volume, and absence of hydrocephalus.Conclusion:For this series, 3R was effective in terms of rapid tumor ablation, V4 decompression, and limited radiation-induced toxicity. This surgical procedure may become an additional tool in the management of intractable posterior fossa metastasis with V4 compression.

Cardiac autonomic response after cranial technique of the fourth ventricle (cv4) compression in systemic hypertensive subjects

ObjectiveThe aim of this study was to compare blood pressure (BP) behavior and heart rate variability (HRV) among hypertensive stage I and normotensive individuals who were submitted to the cranial technique of the 4th ventricle compression (CV4), an osteopathic technique. MethodsIn this experimental controlled study, thirty men between 40 and 60 years old were evaluated and divided into two groups: normotensive (NT) and hypertensive (HT). The CV4 maneuver was applied in both groups and BP was measured at 5 (five) different stages: pre and post-intervention, 5, 10 and 15min after technique. Time-frequency parameters were obtained from measurements of RR intervals. Data were analyzed using an ANOVA two-way for analysis of the condition factor (NT and HT) and times with p-value ≤ .05. ResultsThere was a reduction in the BP of the HT group. A significant intergroup difference (p = .01) was noticed, with respect to the standard deviation of successive normal R-R intervals (SDNN) values, mainly between pre-intervention and 15min stages. Concerning root mean square of the mean squared differences (RNSSD) values, the highlights were differences between pre-intervention and 10min (p = .01) only in the NT group. There was an increase in high frequencies (HF) values and a low frequencies (LF) attenuation in both groups at all different stages. ConclusionThe data showed a BP reduction in the HT group in pre-intervention/15min and an increase in parasympathetic activity and decreased sympathetic activity in both groups. This suggests a change in the sympathetic-vagal balance. However, further studies are needed to elucidate the data on BP reduction mechanisms with CV4.

External Ventricular Drainage in Acute Cerebral Venous Thrombosis with Bilateral Thalamic Infarcts

AbstractCerebral venous thrombosis (CVT) is an uncommon type of stroke with a considerable risk of mortality and morbidity (around 15% overall death or dependency rate in recent meta-analysis). We present the case of a 20-month-old girl who presented with an altered level of consciousness and motor impairment. Imaging studies showed deep CVT with bilateral thalamic edema, resulting in obstructive hydrocephalus due to third ventricle compression. An external ventricular drain was placed, along with intracranial pressure (ICP) monitoring. Evolution was favorable with near-complete neurological recovery. Anticoagulation is the mainstay of treatment of CVT. However, there are very few studies addressing shunting procedures in the management of associated intracranial hypertension. We believe that for patients presenting with bilateral thalamic edema and obstructive hydrocephalus, early shunting and ICP monitoring should be considered.

Retinal haemorrhages in a university hospital: not always abusive head injury.

Retinal haemorrhages (RH) and subdural haematomas (SDH) are frequently seen in abusive head trauma (AHT). The aim of our study is to show that they are suggestive, but not pathognomonic for AHT. We performed an observational retrospective study on children, aged 1-18months old, admitted to the Antwerp University Hospital with RH. History, physical examination, medical course, coagulation and metabolic tests, skeletal survey, head circumference, retinal findings, cerebral imaging, and evaluation reports by social services or civil/criminal courts were collected. Twenty-nine children with RH were included. Twenty three of them were found suspect of AHT. Three children of this group showed intraparenchymal haematomas/infarctions, 5 interhemispheric blood, 6 cerebral oedema, 7 ventricle compression, and 4 papilloedema. Seven of the 16 children with diffusion-weighted MRI images showed diffuse lesions. In 2 of the 6 children not suspect for AHT, an aetiology was found. None of the 4 remaining children showed the above-mentioned abnormalities. Three of these 4 cases showed an accelerated growth of the head circumference months before presentation. The majority of the children in all groups showed 'too numerous to count' (>20) RH (12 of the 23 'suspect' children, and 4 of the 6 'non-suspect' children). Results showed no differences between the groups concerning the location, distribution, or size of the RH. Infants with RH and/or SDH are not necessarily victims of AHT. Cerebral imaging and retinal findings can help differentiate suspect from non-suspect cases. Infants with a large head circumference could be predisposed to RH or SDH.

Factors affecting outcome in posterior fossa EDH: an analytical study at tertiary referral hospital

AbstractIntroduction. Posterior fossa extradural hematomas (PFEDHs) are uncommon as compared to supratentorial EDH and these patients can deteriorate very rapidly due to compression over brainstem. Thus early identification and intervention can save the lives of these patients.Methods. We prospectively studied 114 patients of posterior fossa injury for mode of injury, neurological status during admission, radiological findings, management, and outcomes of patients suffered posterior fossa extradural hematoma. All statistical analyses were determined using the SPSS 22.0.0.0 version. Statistical analysis was conducted utilizing Chi-square test.Results. Out of 114 posterior fossa trauma patients 28 patients (24.56%) having posterior fossa EDH. GCS on admission (p value=0.002), volume of posterior fossa EDH (p value= 0.000) were significant factors for the outcome of posterior fossa EDHs. On comparing the data patients who survived and those who did not survive, the GCS on admission (p value=0.004) and brain stem compression (p value=0.000) were two factors found to affect the mortality significantly.Conclusion. Early detection with high degree of suspicion and immediate evacuation of PFEDHs should be done if causing fourth ventricle, basal cistern or brain stem compression.

Treatment of cystic lesions in sella through transsphenoidal endoscopic endonasal approach: retrospective analysis of 46 cases

To analyze the clinical and imaging characteristics of patients with cystic lesions in sella region and to describe the experience of endoscopic transsphenoidal surgery. Fourty-six cases of cystic lesions in sella region confirmed by surgery and pathology between June 2003 and September 2013 were retrospectively analysed. The clinical features, imaging, surgical technique and postoperative recurrence in 46 cases were presented. All lesions were resected through transsphenoidal endoscopic endonasal approach. Followed up lasted from 6 months to 6 years. Postoperatively, headache was recovered in 26 cases and wasn't recovered in 8 cases, visual was improved in 12 cases and wasn't improved in 2 cases, hypopituitarism was relieved in 18 cases and wasn't relieved in 15 cases, polyuria was disappeared in 8 cases and wasn't disappeared in 4 cases. Seven cases recurred, including 4 cases of craniopharyngioma, 2 cases of pituitary abscess, 1 case of cystic adenoma. There were no death and serious complication. The small age of onset, visual acuity and visual field symptoms, tumor in suprasellar, third ventricle compression was easy to occur in craniopharyngioma; cystic tumor, cavernous sinus invasion, the solid part homogeneous enhancement could be seen in cystic adenoma; Rathke cyst showed simple cystic, lighter clinical symptoms and a short course. Prone to diabetes insipidus, low multiple hormone level and the lesions of annular enhancement was more common in pituitary abscess. The clinical features and imaging of cystic lesions in sella region feature overlap each other, but there are certain specificity. Transsphenoidal endoscopic endonasal approach for the surgery of cystic lesions in sella is effective and safe.

Effects of the Fourth Ventricle Compression in the Regulation of the Autonomic Nervous System: A Randomized Control Trial.

Introduction. Dysfunction of the autonomic nervous system is an important factor in the development of chronic pain. Fourth ventricle compression (CV-4) has been shown to influence autonomic activity. Nevertheless, the physiological mechanisms behind these effects remain unclear. Objectives. This study is aimed at evaluating the effects of fourth ventricle compression on the autonomic nervous system. Methods. Forty healthy adults were randomly assigned to an intervention group, on whom CV-4 was performed, or to a control group, who received a placebo intervention (nontherapeutic touch on the occipital bone). In both groups, plasmatic catecholamine levels, blood pressure, and heart rate were measured before and immediately after the intervention. Results. No effects related to the intervention were found. Although a reduction of norepinephrine, systolic blood pressure, and heart rate was found after the intervention, it was not exclusive to the intervention group. In fact, only the control group showed an increment of dopamine levels after intervention. Conclusion. Fourth ventricle compression seems not to have any effect in plasmatic catecholamine levels, blood pressure, or heart rate. Further studies are needed to clarify the CV-4 physiologic mechanisms and clinical efficacy in autonomic regulation and pain treatment.

Transplanting neural progenitors to build a neuronal relay across the injured spinal cord.

Cellular transplantation for repair of spinal cord injury is a promising therapeutic strategy that includes the use of a variety of neural and non-neural cells isolated or derived from embryonic and adult tissue as well as embryonic stem cells and induced pluripotent stem cells. In particular, transplants of neural progenitor cells (NPCs) have been shown to limit secondary injury and scar formation and create a permissive environment in the injured spinal cord through the provision of neurotrophic molecules and growth supporting matrices that promote growth of injured host axons. Importantly, transplants of NPC are unique in their potential to replace lost neural cells – including neurons, astrocytes, and oligodendrocytes – critical for reconstruction of the normal microenvironment of the spinal cord and restoration of connectivity and function. Different NPC preparations have been used for transplantation experiments in multiple, diverse models of SCI, ranging from the classical work with fetal spinal cord (FSC) that defined the optimal age for donor tissue and its capacity to generate neural cells (Reier et al., 1983; Reier et al., 1986), to studies that demonstrated the formation of a neuronal relay by NPC transplants across the injured spinal cord to reconnect the interrupted sensory system (Bonner et al., 2011). At the developmental stage of embryonic day (E)13.5–14 the FSC is composed primarily of neuronal restricted progenitors (NRP) and glial restricted progenitors (GRP), but also contains a small number of immature neural stem cells, neurons, endothelial cells and fibroblasts (Kalyani et al., 1998; Cai et al., 2002; Lepore and Fischer, 2005; Medalha et al., 2014). While grafts of acutely isolated FSC contain all of these cell subpopulations, the process of isolating and culturing of NRP and GRP from FSC, particularly by adherent, sub-confluent culture on a poly-L-lysine/laminin substrate generates pure, defined, and reproducible populations of progenitors (Cai et al., 2002) for cryopreservation or transplantation experiments. NRP and GRP, in contrast to multipotent NSC have a capacity for self-renewal and a restricted differentiation potential, as they are committed to neuronal and glial phenotypes, respectively (Han et al., 2002; Lepore and Fischer, 2005). The injured spinal cord, however, presents a variety of impediments not only to the regeneration of injured host axons in the form of chondroitin sulfated proteoglycans (CSPG) and myelin-associated byproducts, but also significantly limits the survival and differentiation of graft-derived neurons (Cao et al., 2002; Lepore and Fischer, 2005).

Rapidly Progressing Brainstem Compression Due to a Giant Posterior Fossa Arachnoid Cyst

Rapidly Progressing Brainstem Compression Due to a Giant Posterior Fossa Arachnoid Cyst Case Presentation: A 28 years old woman with lethargy, disorientation, nausea and vomiting was sent to our emergency department (ED) from a state hospital. A cervical magnetic resonance imaging (MRI) was taken there and it revealed a large cystic mass in the posterior fossa causing tonsillar herniation and fourth ventricle compression. A head computerized tomography (CT) with contrast was taken at ED and she was admitted to the neurosurgery ward for further investigation and operation. Within a few hours she was lost her consciousness and developed respiratory arrest. She was taken to operating room emergently and cyst wall fenestration was performed under microscope. During 1 year follow-up she recovered fully in terms of neurological examination.

Can Myofascial Techniques Modify Immunological Parameters?

The objective was to determine the effect of myofascial techniques on the modulation of immunological variables. Thirty-nine healthy male volunteers were randomly assigned to an experimental or control group. The experimental group underwent three manual therapy modalities: suboccipital muscle release, so-called fourth intracranial ventricle compression, and deep cervical fascia release. The control group remained in a resting position for the same time period under the same environmental conditions. Changes in counts of CD3, CD4, CD8, CD19, and natural killer (NK) cells (as immunological markers) between baseline and 20 minutes post-intervention. Repeated-measures ANOVA revealed a significant time × groups interaction (F(1,35)=9.33; p=0.004) for CD19. There were no significant time × group interaction effects on CD3, CD4, CD8, or NK cell counts. Intrasubject analyses showed a higher CD19 count in the experimental group post-intervention versus baseline (t=-4.02; p=0.001), with no changes in the control group (t=0.526; p=0.608). A major immunological modulation, with an increased B lymphocyte count, was observed at 20 minutes after the application of craniocervical myofascial induction techniques.

Role of Early Postradiation Magnetic Resonance Imaging Scans in Children With Diffuse Intrinsic Pontine Glioma

To determine optimal timing of assessing postradiation radiographic response on magnetic resonance imaging (MRI) scans in pediatric patients with diffuse intrinsic pontine glioma (DIPG). Patients were treated on a prospective study at the National Cancer Institute (Protocol #06-C-0219) evaluating the effects of radiotherapy (RT). Standard RT was administered in standard fractionation over 6 weeks. Postradiation MRI scans were performed at 2 and 6-8 weeks. Eleven patients with DIPG were evaluated. Median age was 6 years (range, 4-13 years). Patients were treated with external-beam RT to 55.8 Gy (n = 10) or 54 Gy (n = 1), with a gross tumor volume to planning target volume expansion of 1.8-2.0 cm. All patients received prescribed dose and underwent posttreatment MRI scans at 2 and 6-8 weeks. Pretreatment imaging revealed compression of fourth ventricle (n = 11); basilar artery encasement (n = 9); tumor extension outside the pons (n = 11); and tumor hemorrhage (n = 2). At the 2-week scan, basilar artery encasement improved in 7 of 9 patients, and extent of tumor was reduced in 5 of 11 patients. Fourth ventricle compression improved in 6 of 11 patients but worsened in 3 of 11 patients. Presumed necrosis was observed in 5 of 11 patients at 2 weeks and in 1 additional patient at 6-8 weeks. There was no significant difference in mean anteroposterior and transverse diameters of tumor between the 2- and 6-8-week time points. Six of 11 patients had increasing ventricular size, with no evidence of obstruction. There is no significant difference in tumor size of DIPG patients who have received standard RT when measured at 2 weeks vs. 6-8 weeks after RT. The majority of patients had the largest change in tumor size at the 2-week post-RT scan, with evolving changes documented on the 6-8-week scan. Six of 11 patients had progressive ventriculomegaly without obstruction, suggestive of communicating hydrocephalus. To the best of our knowledge, this is the first documentation of this phenomenon in this cohort of patients.

Prediction of clinical outcome in acute hemorrhagic stroke from a single CT scan on admission

Background:From a single CT scan in primary intracerebral hemorrhage (ICH), clinical outcome can be assessed on admission by using the CT scan parameters.Aims:The study aims to find out how hematoma volume, location of stroke, midline shift, intraventricular extension of bleed and ventricle compression influence the clinical outcome in patients with acute ICH.Materials and Methods:Non-contrast CT scan was done on admission in hospital for every patient with acute hemorrhagic stroke and was analyzed accordingly. Clinical assessments were done in National Institute of Health Stroke Scale (NIHSS). Chi-square test and multiple logistic regression analysis were used for statistical analysis.Results:Mean hematoma volume associated with death before 30 days is 33.16 cm3 (P < 0.0001), with survived after 30 days is 15.45 cm3 (P < 0.0001), with NIHSS score ≥16 is 29.03 cm3 (P < 0.0001) and with NIHSS score <16 is 13.69 cm3 (P < 0.0001). Independent poor prognostic factors were hematoma volume > 30 cm3 (OR = 27.857), brain stem hemorrhage (OR = 6.000), intraventricular extension of bleed from other location (OR = 7.846), presence of ventricular compression alone (OR = 2.700) and in combination with midline shift of ≥ 5 mm (OR = 2.124).Conclusions:From a single CT scan during hospital admission, mortality and morbidity in next 30 days can be predicted. A hematoma volume >30 cm3, brain stem hematoma, intraventricular extension of bleed and ventricular compression along and with midline shift are associated with early mortality in ICH.

Embolic pulmonary complication of a cerebral arteriovenous malformation treatment

A 34-year-old man was admitted in the emergency room with headache, vomiting, gait ataxia, dizziness and vertigo. He was submitted to a cranial CT that showed an important hydrocephalus secondary to a forth ventricle compression by a posterior fossa hematoma. He received advanced life support in an intensive care unit (ICU) and was submitted to an external ventricular drainage (EVD), posteriorly converted to ventriculoperitoneal shunt (VPS) (visualized in the right hemithorax). After stabilization a magnetic resonance image (MRI) and an arteriography revealed a large cerebellum arteriovenous malformation (AVM).

Isolated Vein Thrombosis of the Posterior Fossa Presenting as Localized Cerebellar Venous Infarctions or Hemorrhages

Cerebellar venous infarction or hemorrhage due to isolated venous thrombosis of the posterior fossa is a rare form of intracranial vein thrombosis that can be unsuspected in clinical practice. We studied 230 patients with intracranial vein thrombosis, identifying 9 (3.9%: 7 women, mean age 34 years) with neuroimaging or histopathologic evidence of localized posterior fossa vein thrombosis causing parenchymal injury limited exclusively to the cerebellum. All patients had an insidious presentation suggesting other diagnoses. Intracranial hypertension (n=6) and cerebellar (n=4) syndromes were the main clinical presentations. Intracranial vein thrombosis was idiopathic in 3 patients; associated with puerperium in 3; and with contraceptives, protein C deficiency, and dehydration in 1 case each. CT was abnormal but not diagnostic in 5 patients, showing a cerebellar hypodensity with fourth ventricle compression and variable hydrocephalus in 5 patients, and cerebellar hemorrhage in 2. Conventional MRI provided diagnosis in 6 cases, showing the causal thrombosis and cerebellar involvement; angiography was practiced in 2 of them, confirming the findings identified by MRI. In the other 3 patients, diagnosis was reached by histopathology. Thromboses were localized at the straight sinus (n=4), lateral sinuses (n=3), and superior petrosal vein (n=2). The acute case fatality rate was 22.2% (n=2), 1 (11.1%) patient was discharged in a vegetative state, 1 (11.1%) was severely disabled, and 5 (55.6%) were moderately disabled. Isolated venous thrombosis of the posterior fossa is infrequent and implies a challenging diagnosis. Risk factors for intracranial vein thrombosis and atypical cerebellar findings on CT should lead to further MRI assessment.

Intradural Microsurgery and Extradural Gamma Knife Surgery for Hypoglossal Schwannoma: Case Report and Review of the Literature

There have been only 26 cases of hypoglossal schwannomas reported to originate intradurally and extend extradurally into the hypoglossal canal. This 31-year-old mother of two children presented with a 5-day history of progressive headache, nausea, vomiting and vertigo. Her neurological exam was significant for nystagmus and left tongue deviation with marked atrophy. An initial head CT revealed extensive left hypoglossal canal erosion with 4th ventricle compression. T1-weighted MR images with contrast revealed a 4x3 cm left cerebellopontine angle non-homogeneously enhancing mass with an intracranial cystic component and prominent extension into the eroded hypoglossal canal. A left lateral suboccipital craniotomy was performed for subtotal microsurgical resection of the intradural posterior fossa mass. A schwannoma was diagnosed after resection and gamma knife surgery (GKS) was performed three months later for the extradural residual tumor without further deficits. This is a rare report of a hypoglossal schwannoma in a young patient who was treated with a multimodality approach in order to minimize risks. A review of the literature and discussion of the respective benefits of microsurgery versus GKS and long-term follow-up issues are presented.

Neonatal Macrocephaly: Cerebral Primitive Neuroectodermal Tumor or Neuroblastoma as an Infrequent Cause-A Case Report and Review of the Literature

We report a male term newborn presenting with a congenital macrocephaly 3.5 standard deviations above the median, with a wide and tense anterior fontanel, splayed calvarial sutures, and muscular hypotonia. Antenatal head circumferences were repeatedly below the median. A postnatal head ultrasound showed a large right intracerebral mass with right lateral ventricle compression, right temporal horn dilation, and right frontal horn enlargement with lateral displacement. Additional imaging by computed tomography scan and magnetic resonance imaging was performed. A decompression was performed and histology, immunohistochemistry, and molecular biology supported the diagnosis of a primitive neuroectodermal tumor. A MYCN gene amplification assay remained negative. The incidence of neonatal brain tumors is between 1.4 and 4.1/100,000 live births. Their most common presentation is macrocephaly, hydrocephalus, stillbirth, or diagnosis by pre- or postnatal imaging. Although hydrocephaly and intra- or extracranial hemorrhage are the most frequent causes of congenital macrocephaly, this should be initially investigated by head ultrasound. A suspected malignancy will be confirmed by histopathology, immunohistochemistry, and molecular biology.

Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: differentiation using MRI

To determine the differential magnetic resonance imaging (MRI) features of pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions. The MRI images of 64 patients with pituitary adenoma (n=38), craniopharyngioma (n=13), or Rathke cleft cyst (n=13) were retrospectively reviewed by three neuroradiologists. The following characteristics were evaluated: shape, volume, extent, component characteristics, signal intensities of solid portions on T2-weighted images, signal intensities of cystic portions on T1-weighted images, and enhancement patterns of solid portions and cyst walls of tumours. Fisher's exact test applied with Bonferroni correction was used for multiple comparison. A flowchart for differential diagnosis was constructed based on statistical analysis of the results. A snowman shape, solid characteristics, and homogeneous enhancement of the solid portion were more common in pituitary adenomas (p<0.017). A superiorly lobulated shape, third ventricle compression by superior tumour extension, mixed solid and cystic characteristics, and reticular enhancement of the solid portion were more common in craniopharyngiomas (p<0.017). Finally, an ovoid shape, a small tumour volume, cystic characteristics, and no or thin cyst wall enhancement were more common in Rathke cleft cysts (p<0.017). The flowchart yielded diagnostic accuracies as follows: 92.1% in pituitary adenoma; 92.3% in craniopharyngioma; 92.3% in Rathke cleft cyst; and 92.2% overall. A combination of MRI findings is helpful in the differential diagnosis of the three tumours involving both intrasellar and suprasellar regions.