Expansion diverticulum of the suprapineal recess causing cerebellar ataxia. A case report

As a result of long-standing cerebrospinal fluid (CSF) pulsation against the thinnest segments of the ventricular walls, focal enlargement of the ventricular system (diverticulum) may occur, mainly at the medial wall of the trigone of the lateral ventricles (atrial diverticula) or at the posterior wall of the third ventricle (expansion of the suprapineal recess). In the latter case, ocular signs are the most common symptoms, due to the severe deformation of the periaqueductal region. We describe a case of non-communicating hydrocephalus in a 36-year-old woman who presented a three-year history of cerebellar ataxia. Preoperative brain magnetic resonance (MR) scan showed marked supratentorial hydrocephalus with an apparently patent aqueduct of Sylvius, and an enlarged suprapineal recess causing cerebellar and tentorial dislocation. The patient was successfully treated by endoscopic third ventriculostomy and monitored by MR scans with phase-contrast sequences for assessment of CSF flow. Cerebellar ataxia is a very rare symptomatic onset for a suprapineal recess expansion diverticulum, which may cause obstructive hydrocephalus that can be effectively treated by endoscopic third ventriculostomy.