A 4-year-old boy with macrocephaly (+3 SD) was evaluated with MRI, which showed a subdural hygroma secondary to rupture of a left temporal arachnoid cyst and triventricular enlargement. Two years later, we repeated imaging to explore the possibility of a third ventriculostomy. There was a flow void across the floor of the third ventricle (figure). By using 3D cardiac-gated dynamic imaging, we demonstrated that a spontaneous ventriculostomy had already occurred (video 1, links.lww.com/WNL/B217). Spontaneous third ventriculostomy is rare and can occur in children and adults with chronic hydrocephalus.1
Sagittal heavy T2-weighted midline image. Small flow void (between arrows) can be identified at the floor of the 3rd ventricle.
Video 1
Midline 2D dynamic CSF flow image, ECG-gated. Caudal and cranial flow over the aqueduct and across the floor of the 3rd ventricle are appreciated. The flow across the floor of the third ventricle is suitable with a third ventriculostomy.Download Supplementary Video 1 via http://dx.doi.org/10.1212/010843_Video_1
Study Funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Footnotes
Go to Neurology.org/N for full disclosures.
Teaching slides links.lww.com/WNL/B216
- © 2020 American Academy of Neurology
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