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Spontaneous third ventriculocisternostomy in an infant with obstructive hydrocephalus
1Center for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia. ggallia@jhmi.edu
Journal of Neurosurgery. Pediatrics
|June 4, 2008
Summary
A rare spontaneous ventriculocisternostomy, a communication between the brain's ventricles and subarachnoid space, was observed in an infant with obstructive hydrocephalus. This natural opening resolved the condition, potentially avoiding surgical intervention.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Obstructive hydrocephalus in infants presents with progressive ventriculomegaly and increased head circumference.
- Spontaneous ventriculocisternostomy, a rare event, involves the development of natural communication between the ventricular system and the subarachnoid space.
Observation:
- A case study of an infant with obstructive hydrocephalus who developed a spontaneous third ventriculocisternostomy.
- Clinical monitoring showed normalization of head circumference growth during follow-up.
- Magnetic resonance (MR) imaging confirmed a reduction in hydrocephalus and visualized cerebrospinal fluid (CSF) flow.
Findings:
- Cerebrospinal fluid (CSF) flow was identified through the floor of the third ventricle, specifically between the tuber cinereum and mammillary bodies.
- This flow established a connection between the ventricular system and the prepontine cistern, indicative of ventriculocisternostomy.
- The spontaneous formation of this pathway led to the resolution of obstructive hydrocephalus.
Implications:
- Spontaneous ventriculocisternostomy, though uncommon, is a significant finding in pediatric neurology.
- Recognition of this phenomenon may alter management strategies for infant hydrocephalus.
- This natural CSF diversion pathway could potentially obviate the need for shunting procedures.
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