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Intraventricular aneurysms--three case reports
1Department of Neurosurgery, Osaka Medical College.
Insights
This study details three rare intraventricular aneurysm cases, including a unique fourth ventricle aneurysm. Surgical intervention and spontaneous resolution highlight diverse management outcomes for these critical brain vascular lesions.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Neuroradiology
Background:
- Intraventricular aneurysms are rare vascular lesions within the brain's ventricular system.
- They can cause significant neurological deficits due to intraventricular hemorrhage.
- Moyamoya disease is a potential associated condition.
Observation:
- Three cases are presented: a unique fourth ventricle aneurysm and two lateral ventricle aneurysms associated with moyamoya disease.
- Patients presented with altered consciousness secondary to massive intraventricular hemorrhage.
- Digital subtraction angiography was used for diagnosis.
Findings:
- One idiopathic peripheral aneurysm in the fourth ventricle and two lateral ventricle aneurysms were identified.
- Two aneurysms were surgically treated and confirmed as pseudoaneurysms.
- One lateral ventricle aneurysm resolved spontaneously within two months.
Implications:
- Spontaneous resolution is common, supporting initial conservative management for intraventricular aneurysms.
- Surgical techniques, including stereotactic guidance and midline suboccipital approaches, are effective for resection.
- Advancements in neuronavigation enhance surgical safety and outcomes for these rare conditions.
Abstract:
Three rare cases of purely intraventricular aneurysms are described, including a unique aneurysm in the fourth ventricle. A 30-year-old female, a 47-year-old male, and an 11-year-old girl presented with disturbance of consciousness due to massive intraventricular hemorrhage. Digital subtraction angiography revealed an idiopathic peripheral aneurysm in the fourth ventricle in the first patient, and aneurysms in the lateral ventricle associated with moyamoya disease in the latter two patients. The former two aneurysms were treated surgically and histologically confirmed to be pseudoaneurysms. The latter aneurysm disappeared spontaneously within 2 months after onset. The aneurysm in the lateral ventricle was resected via a parietal corticotomy with stereotactic insertion of an 8-Fr silicone tube to guide the approach route. This method was very useful because computerized neuronavigation was not available. The aneurysm in the fourth ventricle was resected via a midline suboccipital approach with C-1 laminectomy. Conservative treatment is usually recommended initially for patients with intraventricular aneurysm because spontaneous cure often occurs. We recommend direct surgery if the size of the aneurysm remains unchanged, because the risk of surgery has decreased recently owing to new techniques for neuronavigation.