Obstructive hydrocephalus following aqueductal stenosis caused by supra- and infratentorial developmental venous...

We report a rare case of hydrocephalus following aqueductal stenosis caused by developmental venous anomaly (DVA).

Four years after the incidental discovery of asymptomatic DVA, the 10-year-old boy presented with symptoms of hydrocephalus. Enhanced computed tomographic scans and magnetic resonance images showed supra- and infratentorial DVAs with caput medusae appearances in the right basal ganglia and cerebellum. Three dilated collector veins in the right basal ganglia, floor of the third ventricle, and floor of the fourth ventricle gathered together to drain into the great vein of Galen. Three-dimensional fusion images showed that the serpentine dilated vein from the posterior fossa coursed in the aqueduct and caused the aqueductal stenosis, which was confirmed by operative endoscopy.

Endoscopic third ventriculostomy was performed and the hydrocephalus was relieved.

Although aqueductal stenosis caused by DVA is rare, it is important to be considered in the differential diagnosis of hydrocephalus. Three-dimensional reconstruction and fusion images are very useful.