[Case of spontaneous ventriculocisternostomy: with special reference to a CT finding]

Area of Science:

• Neurosurgery
• Radiology
• Neurology

Background:

• Obstructive hydrocephalus can rarely lead to spontaneous ventriculocisternostomy.
• This condition involves the abnormal formation of a cavity connecting the ventricles to the cisterns.

Observation:

• A 23-year-old male presented with headache, tinnitus, decreased visual acuity, and vomiting.
• CT scans revealed significant hydrocephalus, bilateral papilledema, and an accessory cavity behind the third ventricle.
• The cavity communicated with the third ventricle and the quadrigeminal and supracerebellar cisterns, indicating spontaneous ventriculocisternostomy.

Findings:

• The patient was diagnosed with obstructive hydrocephalus due to benign aqueduct stenosis with spontaneous ventriculocisternostomy.
• While spontaneous ventriculocisternostomy can arrest hydrocephalus, symptoms did not regress in this case.
• Literature review indicates a 50% arrest rate for spontaneous ventriculocisternostomy, comparable to surgical methods.

Implications:

• This case underscores the importance of advanced imaging in diagnosing rare complications of hydrocephalus.
• The findings suggest that ventriculoperitoneal (VP) or ventriculoatrial (VA) shunts may offer better outcomes than surgical ventriculocisternostomy for obstructive hydrocephalus.
• Further research is warranted to optimize treatment strategies for obstructive hydrocephalus with spontaneous ventriculocisternostomy.