Choroid Plexus Cyst of the Fourth Ventricle Associated with Intermittent Obstructive Hydrocephalus

Area of Science:

• Neuroepithelial cysts
• Neuro-oncology
• Cerebrospinal fluid dynamics

Background:

• Choroid plexus cysts (CPCs) are typically benign neuroepithelial cysts found in the supratentorial compartment.
• Symptomatic CPCs in the posterior fossa are rare and can lead to obstructive hydrocephalus.

Observation:

• An elderly woman presented with headache, vomiting, and gait instability.
• MRI revealed a large cystic lesion in the fourth ventricle.
• Initial endoscopic fenestration provided only temporary relief.

Findings:

• Histological examination confirmed the lesion as a choroid plexus cyst.
• A second surgery involving gross total resection achieved successful long-term resolution.
• Fourth ventricle CPCs are exceptionally rare in the elderly population.

Implications:

• Fourth ventricle symptomatic CPCs require careful evaluation as a potential cause of intermittent obstructive hydrocephalus.
• While cyst fenestration is often sufficient, aggressive resection may be required in select cases.
• This case highlights the importance of considering rare etiologies for neurological symptoms in the elderly.