Disproportionately large communicating fourth ventricle: two case reports.

Area of Science:

• Neurology
• Neurosurgery
• Medical Imaging

Background:

• The management of a disproportionately large communicating fourth ventricle remains a clinical challenge.
• Communicating hydrocephalus associated with an enlarged fourth ventricle requires careful consideration for effective treatment.

Observation:

• Two successful cases of managing disproportionately large communicating fourth ventricles are presented.
• Case 1: A 51-year-old woman with hydrocephalus and an enlarged fourth ventricle treated with ventriculo-peritoneal shunt, showing complete symptom relief and normal ventricular size post-treatment.
• Case 2: A 24-year-old man with hydrocephalus, enlarged fourth ventricle, crowded posterior fossa, and syringomyelia treated with suboccipital decompression and duraplasty, resulting in symptom resolution, syringomyelia disappearance, and fourth ventricle size reduction.

Findings:

• Successful treatment outcomes were achieved in both presented cases.
• Ventriculo-peritoneal shunting effectively resolved symptoms and normalized ventricular size in a patient without posterior fossa crowding or syringomyelia.
• Posterior fossa decompression proved effective in a patient with associated crowded posterior fossa and syringomyelia, leading to symptom relief and anatomical improvement.

Implications:

• Treatment strategies for a disproportionately large communicating fourth ventricle should be individualized based on associated pathologies.
• Posterior fossa decompression is a viable initial management option when syringomyelia or posterior fossa crowding is present.
• Lateral ventricle shunting may be the preferred initial approach in the absence of these specific posterior fossa abnormalities.