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Regression of cerebellar tonsillar descent and hydrocephalus after endoscopic third ventriculostomy in a patient with a quadrigeminal arachnoid cyst.

Arakawa Y, Kita D, Ezuka I, Hayashi Y, Hamada J, Hayashi Y - Surg Neurol Int (2013)

Bottom Line: This, in turn, can result in obstructive hydrocephalus.Endoscopic third ventriculostomy (ETV) was performed successfully and resulted in complete recovery from her headaches and papilledema.Postoperative MRI revealed resolution of ventriculomegaly and cerebellar tonsillar descent, suggesting that the fourth ventricle outlet obstruction was associated with the development of the hydrocephalus in this patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Joetsu General Hospital, Joetsu, Niigata, Japan - 148-1, Daidoufukuda, Joetsu, 943-8507, Japan.

ABSTRACT

Background: Posterior fossa arachnoid cysts, including quadrigeminal cistern arachnoid cysts, can occasionally cause compression of the quadrigeminal plate, leading to Sylvian aqueduct stenosis and induction of cerebellar tonsillar descent into the foramen magnum. This, in turn, can result in obstructive hydrocephalus. In such cases, the characteristic of hydrocephalus is generally considered to be hypertensive.

Case description: We present the case of a 28-year-old female complaining of chronic and progressively worsening headaches following the delivery of her first child. Magnetic resonance imaging revealed marked tri-ventriculomegaly, the arachnoid cyst located in the quadrigeminal cistern, and cerebellar tonsillar descent. Ophthalmoscopy revealed bilateral papilledema indicating a long-standing elevation of intracranial pressure. Endoscopic third ventriculostomy (ETV) was performed successfully and resulted in complete recovery from her headaches and papilledema. Postoperative MRI revealed resolution of ventriculomegaly and cerebellar tonsillar descent, suggesting that the fourth ventricle outlet obstruction was associated with the development of the hydrocephalus in this patient.

Conclusion: Our case is the first report that a quadrigeminal arachnoid cyst associated with both cerebellar tonsillar descent and hydrocephalus was well treated with ETV. It was indicated that the patient's hydrocephalus and cerebellar tonsillar descent were secondary and synergistic events, caused by the arachnoid cyst located in the quadrigeminal cistern.

No MeSH data available.


Related in: MedlinePlus

(a) A postoperative MRI displayed marked reductions in the size of the lateral and third ventricles. (b) The size of the quadrigeminal cistern arachnoid cyst was also reduced, and normalization of the cerebellar tonsillar descent was observed. The flow void artifact through the stoma with ETV was detected (arrow).
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Figure 3: (a) A postoperative MRI displayed marked reductions in the size of the lateral and third ventricles. (b) The size of the quadrigeminal cistern arachnoid cyst was also reduced, and normalization of the cerebellar tonsillar descent was observed. The flow void artifact through the stoma with ETV was detected (arrow).

Mentions: Her postoperative course was uneventful, and her headaches, left arm numbness, and bilateral papilledema were completely resolved. A postoperative MRI of the brain at the 12-month follow-up displayed marked reductions in size of the lateral and third ventricles and the quadrigeminal cyst; it also revealed normalization of the cerebellar tonsillar descent, and patency of the stoma was clearly indicated by the flow artifact, which is depicted on the postoperative T2-weighted image in Figure 3.


Regression of cerebellar tonsillar descent and hydrocephalus after endoscopic third ventriculostomy in a patient with a quadrigeminal arachnoid cyst.

Arakawa Y, Kita D, Ezuka I, Hayashi Y, Hamada J, Hayashi Y - Surg Neurol Int (2013)

(a) A postoperative MRI displayed marked reductions in the size of the lateral and third ventricles. (b) The size of the quadrigeminal cistern arachnoid cyst was also reduced, and normalization of the cerebellar tonsillar descent was observed. The flow void artifact through the stoma with ETV was detected (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815032&req=5

Figure 3: (a) A postoperative MRI displayed marked reductions in the size of the lateral and third ventricles. (b) The size of the quadrigeminal cistern arachnoid cyst was also reduced, and normalization of the cerebellar tonsillar descent was observed. The flow void artifact through the stoma with ETV was detected (arrow).
Mentions: Her postoperative course was uneventful, and her headaches, left arm numbness, and bilateral papilledema were completely resolved. A postoperative MRI of the brain at the 12-month follow-up displayed marked reductions in size of the lateral and third ventricles and the quadrigeminal cyst; it also revealed normalization of the cerebellar tonsillar descent, and patency of the stoma was clearly indicated by the flow artifact, which is depicted on the postoperative T2-weighted image in Figure 3.

Bottom Line: This, in turn, can result in obstructive hydrocephalus.Endoscopic third ventriculostomy (ETV) was performed successfully and resulted in complete recovery from her headaches and papilledema.Postoperative MRI revealed resolution of ventriculomegaly and cerebellar tonsillar descent, suggesting that the fourth ventricle outlet obstruction was associated with the development of the hydrocephalus in this patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Joetsu General Hospital, Joetsu, Niigata, Japan - 148-1, Daidoufukuda, Joetsu, 943-8507, Japan.

ABSTRACT

Background: Posterior fossa arachnoid cysts, including quadrigeminal cistern arachnoid cysts, can occasionally cause compression of the quadrigeminal plate, leading to Sylvian aqueduct stenosis and induction of cerebellar tonsillar descent into the foramen magnum. This, in turn, can result in obstructive hydrocephalus. In such cases, the characteristic of hydrocephalus is generally considered to be hypertensive.

Case description: We present the case of a 28-year-old female complaining of chronic and progressively worsening headaches following the delivery of her first child. Magnetic resonance imaging revealed marked tri-ventriculomegaly, the arachnoid cyst located in the quadrigeminal cistern, and cerebellar tonsillar descent. Ophthalmoscopy revealed bilateral papilledema indicating a long-standing elevation of intracranial pressure. Endoscopic third ventriculostomy (ETV) was performed successfully and resulted in complete recovery from her headaches and papilledema. Postoperative MRI revealed resolution of ventriculomegaly and cerebellar tonsillar descent, suggesting that the fourth ventricle outlet obstruction was associated with the development of the hydrocephalus in this patient.

Conclusion: Our case is the first report that a quadrigeminal arachnoid cyst associated with both cerebellar tonsillar descent and hydrocephalus was well treated with ETV. It was indicated that the patient's hydrocephalus and cerebellar tonsillar descent were secondary and synergistic events, caused by the arachnoid cyst located in the quadrigeminal cistern.

No MeSH data available.


Related in: MedlinePlus