Surgical treatment of a patient with a giant choroidal fissure cyst: a case report.

INTRODUCTION: Choroidal fissure cysts (CFC) are usually an incidental finding on imaging and lead to morbidity only in rare cases. The aim of this study was to present the case of a patient with a giant CFC and its treatment. CASE REPORT: The patient was a male infant of 9 days of life that presented with symptoms of intracranial hypertension. A CFC measuring 56 × 70 × 86 mm was diagnosed. Endoscopic fenestration of the cyst was performed; however, the communication closed thereafter. A reservoir catheter was inserted, which subsequently became infected and was then replaced by a ventriculoperitoneal shunt. DISCUSSION: The choroidal fissure is a C-shaped cleft located between the fornix and the thalamus separated from the temporal horn by the layer of tela choroidea. The pathophysiology of CFC is still unclear. In our case, initial endoscopic treatment was decided on to avoid shunt-related complications. Currently, there are no guidelines for the best surgical treatment for CFC. CONCLUSION: We describe an atypical case of CFC and analyze the surgical treatment performed. Although endoscopic treatment is recommended for CFC, currently no guidelines exist regarding the best management of the entity.

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

Pediatricmeningiomas are rare and account for only 2.2% of the central nervous system (CNS) tumors. In this age group, they aremore frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of allmeningiomas, the rarity of the case reported here is corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there were no neurological sequelae. With a follow-up of 26 months, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach a considerable size until they cause symptoms and then are diagnosed. In addition, the deep location of the tumor and its proximity to eloquent areas make these tumors a neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of > 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcalosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

Endoscopic treatment of interhemispheric arachnoid cysts.

BACKGROUND: To describe the neuroendoscopic treatment of interhemispheric arachnoid cysts. METHODS: Five children (aged 1-9 months) harboring interhemispheric arachnoid cysts underwent the procedure. The neuroendoscopic technique included cystoventriculostomy and cystocisternostomy. Imaging exams were compared before and after surgery, and the differences in cyst diameters were calculated. Head circumference and neurological development were also evaluated. RESULTS: The cystoventriculostomy was performed through the lateral ventricle in 4 cases and through the third ventricle in 4 cases. An added cystocisternostomy was performed in 1 case. Cyst diameters were reduced in the anterior-posterior, lateral-medial and superior-inferior planes in 22, 31 and 31% of the cases, respectively. The rate of increasing head circumference slowed; however, all the children continued to show slight macrocrania. There were complications in 2 cases: cerebrospinal fluid fistula was managed by lumbar puncture in 1 case and subdural collection was treated with a shunt in another single case. CONCLUSION: The neuroendoscopic approach to interhemispheric arachnoid cysts was effective with few complications.

"Full moon" endoscopic sign in intraventricular neurocysticercosis.

INTRODUCTION: Despite improvements in sanitation, diagnosis and treatment, neurocysticercosis is still a public health problem in many countries. In symptomatic patients, there is a broad spectrum of clinical manifestations. When cysticerci are lodged in the ventricles or the subarachnoid space, the flow of cerebrospinal fluid can be obstructed and lead to hydrocephalus and intracranial hypertension. The endoscopic view may be useful as a diagnostic tool. PATIENTS: This report clearly shows a common endoscopic pattern in 4 selected patients with ventricular cysticercosis (2 third ventricle/2 lateral ventricle). The endoscopic view of the cysts in the ventricles resembles a "full moon". This analogy helped to identify the features of cysticerci with intact walls and the vesicular stage, malleable due to its cystic content and having an irregular surface, as evidence of the microscopic structure of the cyst wall in a cysticercus. CONCLUSIONS: This finding is not seen in other intraventricular cysts or tumors that can actually be considered as an additional diagnostic criterion among the definitive findings to establish the diagnosis of cysticercosis, since it involves direct endoscopic visualization of a cysticercus under histopathological demonstration. Additionally, the endoscopic approach can be used as primary treatment for these cases, following the minimally invasive approach principle.

Simulation of endoscopic third ventriculostomy in fresh cadaveric specimens.

OBJECTIVE: The purpose of this research is to describe and analyze the endoscopic anatomy of cerebral ventricles, especially of the lateral ventricle and third ventricle. METHODS: 47 brains of adult human cadavers were studied at the Death Check Unit (DCU) of São Paulo. Age, sex, day and approximate time of death, day and time of study, cause of death, outcome of puncture and number of attempts were recorded. A rigid neuroendoscope was utilized. The approach to the ventricular system was via the pre-coronal point on the right side. RESULTS: The number of individuals studied was 47, of which 22 (47%) were women and 25 (53%) were men. Age ranged from 20 to 95 years. The minimum time lag between the death and the study was 8 h and the maximum time was 29 h. Of the cadavers studied, three presented alterations in the central nervous system as the cause of death. Successful puncture was obtained in 42 (89%) being 72% in the first attempt. In the analysis performed by Fisher's exact test with a 5% level of significance, an association between the number of attempts (2) and the cause of cerebral death was found (p=0.018). CONCLUSIONS: The visualization of neural structures without bleeding, the possibility of training techniques such as third ventriculostomy, the development of new techniques and to help sctructure new concepts about anatomic landmarks have by far overcome the difficulties.

Description of endoscopic ventricular anatomy in myelomeningocele.

OBJECTIVE: The purpose of this work is to present our endoscopic neuroanatomical findings of a series of myelomeningocele and hydrocephalus patients, treated with endoscopic third ventricular cisternostomy (ETVC), in order to describe ventricular configuration abnormalities in this group of patients, in which this neurosurgical procedure has limited performance. METHOD: We checked the videos of 10 endoscopic third ventricular cisternostomies of myelomeningocele patients taken during 24 months as from December 1998. A previous guideline is designed to record anatomic variables in the lateral ventricles, IIIrd ventricle, and basal cisterns. The topic is analyzed in view of the necropsy and imaging background data. RESULTS: The ETVC of lateral ventricles showed: absence of septum (9/10); absence of anteroseptal vein (8/10); absence of choroid plexus and thalamostriate vein (0/10); absence of fornix (1/10): small foramen of Monro (4/10). The ETVC of the IIIrd ventricle showed: impossibility of recognizing any mammillary bodies (4/10); presence of septations (5/10); presence of atypical veins in the floor (6/10); translucent floor (5/10); floor umbilications (5/10); absence of infundibulum (4/10); arachnoid adherences (7/10); and visual contact of basilar artery (4/10). CONCLUSION: There are categorical structural alterations in the ventricular system of myelomeningocele patients that are well correlated with previous necropsy and imaging reports. The ventricular system of dysraphic children presents severe anatomic alterations, which alter the reference points of the classical endoscopic third ventricular cisternostomy.

[Cavernoma of the lateral ventricle: case report]. / Cavernoma do ventrículo lateral: relato de caso.

UNLABELLED: Cavernous malformations are uncommon lesions that are usually present in the cerebral hemispheres. They occur rarely in the ventricular system, and even more rarely in the lateral ventricle. Only 28 cases have been previously reported in the literature. CASE: We present one case of lateral ventricle cavernoma in a 15-years-old female patient, who suffered of mild chronic headache for 8 months, followed by two episodes of sudden intensive headache and stupor with complete recovery after 48 hours. CT scan was performed and revealed a voluminous size, hiperdense mass in the frontal horn of the lateral ventricle. The surgical access to site was through transcallosal interhemisphere approach. The patient had a good recovery without complications. CONCLUSION: Although lateral ventricle cavernomas are rare they should be considered in the differential diagnosis of intraventricular tumors. A wrong preoperative diagnosis has sometimes induced a wrong therapy, such as radiotherapy, for these surgically curable benign lesions.

Lateral ventricle tumors in children: a series of 54 cases.

A series of 54 patients with lateral ventricle tumors diagnosed and surgically treated from 1988 to 1998 was reviewed. Neoplasms invading ventricles and originating beyond their walls were excluded. There were 35 male and 19 female patients. Their ages ranged from 15 days to 20 years, and two frequency peaks were observed, one at 2 and one at 11 years. The most frequent signs and symptoms were attributed to increased intracranial pressure. The 54 patients included 41 who developed hydrocephalus, but only 15 of these required shunting. The trigonal region and frontal horn were the most common sites of origin. Surgery was planned with due consideration for the localization of the tumor, its presumptive histology, its main feeding vessels, the parenchymal functionality, and the presence or absence of hydrocephalus. The most frequent tumor types were subependymal giant cell astrocytoma, choroid plexus tumors, ependymoma, and astrocytoma. The most common complications were intraventricular hemorrhage, cortical collapse, subdural collection and seizures. To conclude, tumors located within the lateral ventricles are often very voluminous and are predominantly benign, and the treatment of choice is total resection. In the case of malignancy, postsurgical radiotherapy and/or chemotherapy should be given.