Congenital Fourth Ventricular Midline Outlet Obstruction: Report of two cases

Rifkinson-Mann, Stephanie; Sachdev, Ved P.; Huang, Yung Peng

doi:10.1007/978-3-662-11152-9_22

Cited by 7 publications

(17 citation statements)

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“…6,9) A late symptomatic presentation is supposedly explained by a late decompensation of the semipermeable property of these congenital or acquired membranes. 4,5,8) In accordance with this theory, the age range of our patients was between 21 years and 44 years.…”

Section: Discussionsupporting

confidence: 81%

“…Although due to the dilatation of the fourth ventricle, it may be a downward displacement of the tonsils without true herniation. 2,3,5,6,8) In our group, all patients had Chiari Type I malformation, tetraventricular dilatation, and downward displacement of the posterior fossa structures and wide-spread syringomyelia.…”

Section: Discussionmentioning

confidence: 69%

“…2,3,5,6,8) High resolution MRI may directly visualize the membrane of the foramen of Magendie. The membrane may be thick and strong or transparent or semidiaphanous.…”

Section: Discussionmentioning

confidence: 99%

“…6) However, some authors reported that the cases who performed fourth ventriculostomy did not require the placement of a catheter to maintain its patency. 4,5,10) Posterior fossa craniotomy and membrane excision are still advocated by some. 10,11) Suboccipital craniectomy is an invasive procedure; suboccipital craniectomy with microsurgical exploration of the foramen of Magendie and excision of the obstructing membranes with or without a catheter to maintain the communication between the ventricular cavity and the subarachnoid space is a more physiological approach.…”

Section: 7)mentioning

confidence: 99%

“…Congenital occlusive lesions occur primarily in children and are seen mainly in association with Chiari malformations, Dandy-Walker cysts, tuberous sclerosis, spina bifida, platybasia, acondroplasia, basilar impression, and atlantooccipital fusion. [1][2][3][4][5][6] Idiopathic stenosis or closure of the foramina of Magendie and Luschka indicated upper extremity paresis and hyperactive reflexes, bilaterally Hoffmann's sign. The proximal muscle group was 4/5, and distal group was 2/5.…”

Section: Introductionmentioning

confidence: 99%

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Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Orakdogen¹,

Emon²,

Erdoğan³

et al. 2015

NMC Case Report Journal

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is a rare cause of obstructive hydrocephalus.7) However, a distinct subgroup of patients present with radiological evidence of FVOO, in their adulthood, without any significant underlying etiology.3) It is most often seen associated with an underlying pathology that is responsible for the inflammation and scarring of the outlet foramina; however, there have been a few reports in which no predisposing causes have been identified. Histopathological evaluation of the membrane has revealed neural tissue and gliosis without any active inflammation. 4)The treatment for these malformations is still controversial. Hydrocephalus can be treated with cerebro-spinal fluid (CSF) shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, and endoscopic third ventriculostomy (ETV) or endoscopic fourth ventriculostomy. Materials and MethodsInformed patient consent was obtained for this procedure. All patients' data are summarized in Table 1. A 40-year-old man approached us with complaints of headache and neck pain. The patient's neurological examination was normal. Magnetic resonance imaging (MRI) revealed tetraventricular hydrocephalus, dilatation level of aquaductus Sylvii, tonsillar ectopia, and compression to the brain stem and cerebellum, and a membrane causing an obstruction at the level of foramen Magendie. Cervical MRI showed syringomyelia between C1 and C7. Cine-MR revealed no CSF f low through the foramen Magendie and foramen magnum. At the level of aquaductus Sylvii, turbulence, and tertiary flow were observed.Second patient; a 44-year-old woman presented with weakness in bilateral upper extremity. She complained of numbness in the arms, defect in discriminating between hot and cold, and difficulty in swallowing. MRI showed tetraventricular hydrocephalus, tonsillar ectopia, and syringomyelia between C1 and L1. Neurological examination showed left 11th and 12th cranial nerve deficiency, reduced GAG reflex, quadriparesis, hyperactive reflexes, and bilaterally ankle clonus.Third patient; a 33-year-old woman complained of headache. MRI revealed tetraventricular hydrocephalus and Chiari Type I malformation with syringomyelia between C1 and C5. Neurological examination was normal.Fourth patient; a 21-year-old man presented with weakness in the hands and urinary incontinence. MRI demonstrated tetraventricular hydrocephalus, tonsillar ectopia, and syringomyelia between C1 and L1. Neurological examinationWe present four cases of hydrocephalus caused by occlusion of foramen of Magendie associated with Chiari Type I malformation and syringomyelia. The aim of this study is to evaluate the results of surgical treatment via fourth ventriculostomy with catheter from the fourth ventricle to the upper cervical subarachnoid space. Obstructive tetraventricular hydrocephalus due to occlusion of the foramina of Luschka and Magendie can be treated with cerebro-spinal fluid shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, endoscopic third ventriculostomy, and endoscopic four...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 69%

“…2,3,5,6,8) High resolution MRI may directly visualize the membrane of the foramen of Magendie. The membrane may be thick and strong or transparent or semidiaphanous.…”

Section: Discussionmentioning

confidence: 99%