Disproportionately large communicating fourth ventricle: two case reports

Abstract

Background: Management of the disproportionately large communicating fourth ventricle is still problematic. Case presentation: Two cases of disproportionately large communicating fourth ventricle were treated successfully. One was a case of a 51-year-old Han Chinese woman with a complaint of headache and dizziness of 1 year's duration. Magnetic resonance imaging (MRI) demonstrated hydrocephalus with a disproportionately large fourth ventricle. She underwent a ventriculo-peritoneal shunt of the right lateral ventricle. Her symptoms were relieved totally. Five years later, magnetic resonance imaging showed she had a normal ventricular system. The other case was a 24-year-old Han Chinese man with a 2-month history of headache and dizziness accompanied by progressive loss of bilateral vision. Magnetic resonance imaging revealed hydrocephalus with a disproportionately large fourth ventricle, crowded posterior cranial fossa, and syringomyelia extending from C1 to C5. He underwent suboccipital and C1 decompression and duraplasty. Shortly after the surgery, his symptoms were relieved completely, the syringomyelia completely disappeared, and the fourth ventricle became significantly smaller. Conclusions: The management of the disproportionately large communicating fourth ventricle should be individualized. If it coexists with crowded posterior cranial fossa or syringomyelia, posterior fossa decompression could be an option for initial management. If there is no sign of crowded posterior cranial fossa or syringomyelia, shunt of the lateral ventricles might be the first choice.

Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

“…DLCFV is a rare disease characterized by dilatation of the fourth ventricle regardless of lateral ventricle size without definite obstruction of the cerebral aqueduct, indicating patency of the inlet of the fourth ventricle [3]. Its treatment has not been thoroughly established owing to the characteristic hemodynamics of the CSF and a poor understanding of its etiology and pathophysiology [2,4]. Treatment for obstructive hydrocephalus includes ventricular drainage, ventriculoperitoneal shunting Kawabata et al [3] proposed the diagnosis of DLCFV using radiologic imaging of a dilated fourth ventricle and intraoperative endoscopic findings of a patent aqueduct of Sylvius and suggested ETV as a first-line treatment.…”

“…The search revealed 14 patients who were diagnosed with DLCFV and underwent various successful treatments (Table 2). Lyu et al [2] suggested that DLCFV treatment be individualized. As DLCFV is characterized by a patent aqueduct of Sylvius, it is reasonable to assume that most patients with DLCFV can benefit from supratentorial CSF shunt placement; however, not all are treated because of unresolved infratentorial-supratentorial pressure gradients.…”

“…DLCFV is often confused with an isolated fourth ventri-Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report cle (IFV), also known as a trapped or encysted fourth ventricle. IFV is defined as a markedly dilated fourth ventricle due to obstruction of the aqueduct of Sylvius and foramina of Magendie and Luschka [2], whereas DLCFV features a dilated fourth ventricle but a patent aqueduct of Sylvius with no definite obstruction [3].…”