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February 23, 2021; 96 (8) Resident & Fellow Section

Teaching Video NeuroImages: Spontaneous Third Ventriculostomy

Maud P. Tijssen, Erwin M.J. Cornips, Joost Nicolai
First published September 9, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010843
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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

Figure
Figure Midline Sagittal MRI

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

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No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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Reference

  1. 1.↵
    1. Ogrenci A,
    2. Eksi MS,
    3. Koban O
    . Spontaneous third ventriculostomy 8 years after diagnosis of obstructive hydrocephalus. Childs Nerv Syst 2016;32:1727–1730.
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