Advertisement

Postinflammatory Cysts (Loculated Ventricles)

  • Enrique C. G. Ventureyra
  • Michael J. Higgins
Part of the Principles of Pediatric Neurosurgery book series (PRINCPEDIATR)

Abstract

Postinflammatory cystic hydrocephalus is an infrequent and perplexing clinical entity that is frustratingly difficult to treat. Typically associated with inflammatory ventricular processes such as meningitis, severe intraventricular hemorrhages, or ventriculitis, it has been variously termed “multiloculated hydrocephalus,” “multiloculated ventricles,” “ventricular compartmentalization,” “septate ventricles,” or “polycystic brain disease.” Its simpler forms have been designated as “trapped” or “isolated” ventricles. These simpler forms, such as unilateral isolation of the lateral ventricle, present a problem easily remedied; more complex instances often defy the dedicated treatment of a persistent surgeon. These latter instances are seldom discussed in major texts or reviews of hydrocephalus and its treatment and complications.

Keywords

Fourth Ventricle Intraventricular Hemorrhage Aqueductal Stenosis Neonatal Meningitis Ventricular Shunt 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Spiller WG: Two cases of partial internal hydrocephalus from closure of the intraventricular passages: with remarks on bilateral contractions caused by a unilateral cerebral lesion. Med Sei 124:44–55, 1902.Google Scholar
  2. 2.
    Salmon JH: Isolated unilateral hydrocephalus following ventriculoatrial shunt. J Neurosurg 32:219–226, 1970.PubMedGoogle Scholar
  3. 3.
    Savolaine ER, Gerber AM: Computerized tomography studies of congenital and acquired cerebral intraventricular membranes: report of two cases. J Neurosurg 54:388–391, 1981.PubMedGoogle Scholar
  4. 4.
    Von Mohr: Caspers Wochenschr 121:2–15, 1842. (cited by Russell, Ref. 8)Google Scholar
  5. 5.
    Cushing H: Surgery of the head. In: Keen WW (ed.). Surgery. Its Principles and Practice, Vol. 3. WB Saunders, Philadelphia, 1908, 142–143.Google Scholar
  6. 6.
    Dott NM: A case of left unilateral hydrocephalus in an infant. Operation-cure. Brain 56:548–561, 1927.Google Scholar
  7. 7.
    Cairns H, Daniel P, Johnson RT, et al.: Localized hydrocephalus following penetrating wounds of the ventricle. Br J Surg War Surgery Suppl 1:187–197, 1947.Google Scholar
  8. 8.
    Russell DS: Observations on the pathology of hydrocephalus. Medical Research Council Special Report No. 265. His Majesty’s Stationery Office, 1949.Google Scholar
  9. 9.
    Davidoff LM: Coarctation of the walls of the lateral angles of the lateral cerebral ventricles. J Neurosurg 3:250–256, 1946.PubMedGoogle Scholar
  10. 10.
    Kaufman B, Weiss MH, Young HF, et al.: Effects of prolonged cerebrospinal fluid shunting on the skull and brain. J Neurosurg 38:288–297,1973.PubMedGoogle Scholar
  11. 11.
    Linder M, Diehl JT, Sklar FH: Significance of postshunt ventricular asymmetries. J Neurosurg 55:183–186, 1981.PubMedGoogle Scholar
  12. 12.
    Bering EA Jr: Circulation of the cerebral spinal fluid: demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement. J Neur-surg, 19:405–412 1962.Google Scholar
  13. 13.
    Lorber J, Pickering D: Incidence and treatment of post-meningitic hydrocephalus in the newborn. Arch Dis Child 44:41–50,1966.Google Scholar
  14. 14.
    Milhorat TH: Hydrocephalus and the cerebrospinal fluid. Williams and Wilkins, Baltimore, 1972.Google Scholar
  15. 15.
    Milhorat TH: Comment. Neurosurgery 7:559, 1980.Google Scholar
  16. 16.
    Schultz P, Leeds NE: Intraventricular septations complicating neonatal meningitis. J Neurosurg 38:620–626, 1973.PubMedGoogle Scholar
  17. 17.
    Hoffman JC Jr: Application of computerized axial tomography (CT) in pediatric surgery. In: O’Brien MS (ed.). Pediatric Neurological Surgery. Seminars in Neurological Surgery. Raven Press, New York, 1978.Google Scholar
  18. 18.
    Hawkins JC III, Hoffman HJ, Humphreys RP: Isolated fourth ventricle as a complication of ventricular shunting: report of three cases. J Neurosurg 49:910–912, 1978.PubMedGoogle Scholar
  19. 19.
    Zimmerman RA, Bilaniuk LT, Gallou E: Computed tomography of the trapped fourth ventricle. Am J Roentgenol 130:503–506, 1978.Google Scholar
  20. 20.
    Brown LW, Zimmerman RA, Bilaniuk LT: Polycystic brain disease complicating neonatal meningitis: documentation of evolution by computed tomography. Pediatrics 94:757–759, 1979.Google Scholar
  21. 21.
    Kaisbeck JE, DeSousa AL, Kleiman MB, et al.: Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis. J Neurosurg 52:547–552, 1980.Google Scholar
  22. 22.
    Scotti G, Musgrave MA, Fitz CR, et al.: The isolated fourth ventricle in children: CT and clinical review of 16 cases. AJR 135:1233–1238, 1980.PubMedGoogle Scholar
  23. 23.
    Albanese V, Tomasello F, Sampaolo S: Multi-loculated hydrocephalus in infants. Neurosurgery 8:641–646, 1981.PubMedGoogle Scholar
  24. 24.
    Collada M Jr, Kott J, Kline D: Documentation of fourth ventricle entrapment by metrizamide ventriculography with CT scanning: report of two cases. J Neurosurg 55:838–840, 1981.PubMedGoogle Scholar
  25. 25.
    McLone DG, Killion M, Yogev R, et al.: Ventriculitis of mice and men. In: Raimondi AJ (ed.). Concepts in Pediatric Neurosurgery II. S. Kaerer, New York, 1982, 112–126.Google Scholar
  26. 26.
    Black PM, Levine BW, Picard EH, et al.: Asymmetrical hydrocephalus following ventriculitis from rupture of a thalamic abscess. Surg Neurol 19:524–527, 1983.PubMedGoogle Scholar
  27. 27.
    Epstein F: How to keep shunts functioning, or “The Impossible Dream.” Clin Neurosurg 32:608–631, 1984.Google Scholar
  28. 28.
    Eller TW, Pasternak JF: Isolated ventricles following intraventricular hemorrhage. J Neurosurg 62:357–362, 1985.PubMedGoogle Scholar
  29. 29.
    Aoki N: Communicating fourth ventricle hydrocephalus: case report. Neurosurgery 20: 806–808, 1987.PubMedGoogle Scholar
  30. 30.
    O’Hare AE, Brown JK, Minns RA: Specific enlargement of the fourth ventricle after ventriculo-peritoneal shunt for post-haemorrhagic hydrocephalus. Arch Dis Child 62:1025–1029, 1987.PubMedGoogle Scholar
  31. 31.
    Raimondi AJ: Hydrocephalus. In: Raimondi AJ (ed.). Pediatric Neurosurgery Theoretical Principles. Art of Surgical Techniques. Springer-Verlag, New York, 1987, Chap. 15, 453–491.Google Scholar
  32. 32.
    Coker SB, Anderson CL: Occluded fourth ventricle after multiple shunt revisions for hydrocephalus. Pediatrics 83:981–985, 1989.PubMedGoogle Scholar
  33. 33.
    Smith KM, Deddish RB, Ogata ES: Meningitis associated with serial lumbar punctures and post-hemorrhagic hydrocephalus. J Pediatr 106:1057–1060, 1936.Google Scholar
  34. 34.
    Allan WC: Intraventricular hemorrhage. J Child Neurol 4:S12–S22, 1989.PubMedGoogle Scholar
  35. 35.
    Dykes FD, Dunbar B, Lazarra A, et al.: Post-hemorrhagic hydrocephalus in high-risk pre-term infants: natural history, management, and long-term outcome. J Pediatr 114:611–618, 1989.PubMedGoogle Scholar
  36. 36.
    Milhorat TH: Comment. Neurosurgery 6:98, 1980.Google Scholar
  37. 37.
    Harbaugh RE, Saunders RL, Edwards WH: External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants. J Neurosurg 55:766–770, 1981.PubMedGoogle Scholar
  38. 38.
    Volpe JJ: Intracranial hemorrhage: periventricular-intraventricular. In: Volpe JJ (ed.). Neurology of the Newborn. Major Problems in Clinical Pediatrics, Vol. XXII. WB Saunders, Philadelphia, 1981, 262–298.Google Scholar
  39. 39.
    Cheek WR, Desmond MM: Intraventricular hemorrhage and hydrocephalus in the preterm infant. In: Raimondi AJ (ed.). Concepts in Pediatric Neurosurgery, Vol. 3. S. Karger, New York, 1983,126–132.Google Scholar
  40. 40.
    Volpe JJ, Herscovitch P, Perlman JM, et al.: Positron emission tomography in the newborn: extensive impairment of regional cerebral blood flow with intraventricular hemorrhage and hemorrhagic intracerebral involvement. Pediatrics 75:589–601, 1983.Google Scholar
  41. 41.
    Hill A, Shakelford GD, Volpe JJ: A potential mechanism of pathogenesis for early posthemorrhagic hydrocephalus in the premature newborn. Pediatrics 73:19–21, 1984.PubMedGoogle Scholar
  42. 42.
    Volpe JJ: Intraventricular hemorrhage and brain injury in the premature infant. Neuropathology and pathogenesis. In: Volpe JJ (ed.). Clinics in Perinatology. Neonatal Neurology. WB Saunders, Philadelphia, 1989, 16:361–386.Google Scholar
  43. 43.
    Rhoton AL, Gomez MR: Conversion of multilocular hydrocephalus to unilocular. J Neurosurg 36:348–350, 1972.PubMedGoogle Scholar
  44. 44.
    Berman PH, Banker BQ: Neonatal meningitis: a clinical and pathological study of 29 cases. Pediatrics 38:6–24, 1966.PubMedGoogle Scholar
  45. 45.
    Lee EL, Robinson MJ, Thong ML, et al.: Intraventricular chemotherapy in neonatal meningitis. J Pediatr 91:991–995, 1977.PubMedGoogle Scholar
  46. 46.
    Anonymous: Hazard of intraventricular antibiotics in neonatal meningitis. Med Lett Drugs Ther 21:52, 1979.Google Scholar
  47. 47.
    Kaisbeck JE: Comment. Neurosurgery 8:646, 1981.Google Scholar
  48. 48.
    Rhoton AL: Comment. Neurosurgery 8:646, 1981.Google Scholar
  49. 49.
    Raimondi AJ, Bailey OT, McLone, DG, et al.: The pathophysiology and morphology of murine hydrocephalus in hy-3 and ch mutants. SurgNeurol 1:50–55, 1973.Google Scholar
  50. 50.
    McLone DG, Bondareff W, Raimondi AJ: Hydrocephalus-3, a murine mutant: II. Changes in the brain extracellular space. Surg Neurol 1:233–242, 1973.PubMedGoogle Scholar
  51. 51.
    Raimondi AJ: Aqueductal stenosis. In: Raimondi AJ (ed.). Concepts in Pediatric Neurosurgery II. S. Karger, New York, 1982, 45–62.Google Scholar
  52. 52.
    Papile LA, Burstein J, Burstein R, et al.: Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr 92:529–534, 1978.PubMedGoogle Scholar
  53. 53.
    Ment LR, Duncan CC, Scott DT, et al.: Post-hemorrhagic hydrocephalus. J Neurosurg 60:343–347, 1984.PubMedGoogle Scholar
  54. 54.
    G Kaiser: The value of multiple shunt systems in the treatment of nontumoral infantile hydrocephalus. Childs Nerv Syst 2:200–205, 1986.PubMedGoogle Scholar
  55. 55.
    Holt PJ: Posthemorrhagic hydrocephalus. J Child Neurol 4:S23–S31, 1989.PubMedGoogle Scholar
  56. 56.
    McLaurin RL: Ventricular shunts: complications and results. In: McLaurin RL, Schut L, Venes JL, et al. (eds.). Pediatric Neurosurgery, 2nd ed. Surgery of the Developing Nervous System. WB Saunders; Philadelphia, 1989, 219–229.Google Scholar
  57. 57.
    Roberts JP, Bürge DM: Ventricular shunting for hydrocephalus following intraventricular hemorrhage. Z Kinderchir 44(suppl 1): 32–34, 1989.PubMedGoogle Scholar
  58. 58.
    Serlo W, Fernell E, Heikkinen E, et al.: Functions and complications of shunts in different etiologies of childhood hydrocephalus. Childs Nerv Syst 6:92–94, 1990.PubMedGoogle Scholar
  59. 59.
    Galassi E, Tognetti F, Frank F, et al.: Infra-tentorial arachnoid cysts. J Neurosurg 63:210–217, 1985.PubMedGoogle Scholar
  60. 60.
    Foltz EL, Shurtlefï DB: Conversion of communicating hydrocephalus to stenosis or occlusion of the aqueduct during ventricular shunt. J Neurosurg 24:520–529, 1965.Google Scholar
  61. 61.
    Foltz EL, DeFeo DR: Double compartment hydrocephalus—a new clinical entity. Neurosurgery 7:551–559, 1980.PubMedGoogle Scholar
  62. 62.
    O’Brien MS: Comment. Neurosurgery 7:559, 1980.Google Scholar
  63. 63.
    Lourie H, Shende MC, Krawchenko J, et al.: Trapped fourth ventricle: a report of two unusual cases. Neurosurgery 7:279–282, 1980.PubMedGoogle Scholar
  64. 64.
    Mickle JP, Friedman WA: Encysted fourth ventricle. Surg Neurol 16:150–153, 1981.PubMedGoogle Scholar
  65. 65.
    Raimondi AJ, Samuelson G, Yarzagaray L, et al.: Atresia of the foramina of Luschka and Magendie: the Dandy-Walker cyst. J Neurosurg 31:202–216, 1969.PubMedGoogle Scholar
  66. 66.
    Carmel PW, Antones JL, Hilal SK, et al.: Dandy-Walker syndrome: Clinicopathological features and re-examination of modes of treatment. SurgNeurol, 8:132–138, 1977.Google Scholar
  67. 67.
    DeFeo D, Foltz EL, Hamilton AW: Double compartment hydrocephalus in a patient with cysticercosis meningitis. Surg Neurol 4:247–251, 1975.Google Scholar
  68. 68.
    Raimondi AJ: Hydrocephalus. In: Raimondi AJ (ed.). Pediatric Neuroradiology. WB Saunders, Philadelphia, 1972, Chap 3, 347–389.Google Scholar
  69. 69.
    Foltz EL: Comment. Neurosurgery 1:282, 1980.Google Scholar
  70. 70.
    Rekate HL: Treatment of hydrocephalus. In: McLaurin RL, Schut L, Venes JL, et al. (eds.). Pediatric Neurosurgery, 2nd ed. Surgery of the Developing Nervous System. WB Saunders, Philadelphia, 1989, 200–218.Google Scholar
  71. 71.
    Oi S, Matsumoto S: Slit ventricles as a cause of isolated ventricles after shunting. Childs Nerv Syst 1:89–93, 1985.Google Scholar
  72. 72.
    Wolsen BJ, Faerber EN, Truex RC: The “keyhole:” a sign of herniation of a trapped fourth ventricle and other posterior fossa cysts. Am J Neuroradiol 8:473–477, 1987.Google Scholar
  73. 73.
    Alexander E, Botterell EH: Unilateral hydrocephalus resulting from occlusion of foramen of Monro. Complication of radical removal of brain abscess. J Neurosurg 6: 197–206,1949.PubMedGoogle Scholar
  74. 74.
    Milhorat TH, Hammock MK, Breckbill DL: Acute unilateral hydrocephalus resulting from oedamatous occlusion of foramen of Monro: complication of intraventricular surgery. Neurol Neurosurg Psychiatry 38:745–748, 1975.Google Scholar
  75. 75.
    Wilberger JE Jr, Vertosick FT Jr, Vries JK: Unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro. J Neurosurg 59:899–901, 1983.PubMedGoogle Scholar
  76. 76.
    Oi S, Matsumoto S: Pathophysiology of nonneoplastic obstruction of the foramen of Monro and progressive unilateral hydrocephalus. Neurosurgery 17:891–896, 1985.PubMedGoogle Scholar
  77. 77.
    Chadduck WM, Glasier CM: Megachoroid as a cause of isolated ventricle syndrome. Pediatr Neurol 5:194–196, 1989.PubMedGoogle Scholar
  78. 78.
    Venkataramana NK, Sastry Kolluri VR, Narayana Swamy KS, et al.: Progressive unilateral hydrocephalus in adults. Neurosurgery 24:282–284,1989.PubMedGoogle Scholar
  79. 79.
    Maurice-Williams RS, Choksey M: Entrapment of the temporal horn: a form of focal obstructive hydrocephalus. J Neurol Neurosurg Psychiatry 49:238–242, 1986.PubMedGoogle Scholar
  80. 80.
    Netanyahu I, Grant EG: Prominent choroid plexus in meningomyelocele: sonographic findings. AJNR 7:317–321, 1986.PubMedGoogle Scholar
  81. 81.
    Sande MA, Scheid WM, McCracken GH: Summary of a workshop: pathophysiology of bacterial meningitis—implications for new management strategies. Pediatr Infect Dis J 6:1167–1171, 1987.Google Scholar
  82. 82.
    Rubin RC, Hochwald G, Tiell M, et al.: Reconstitution of the cerebral cortical mantle in shunt-corrected hydrocephalus. Dev Med Child Neurol 17(suppl 35): 151–156, 1975.Google Scholar
  83. 83.
    Mustafa MM, Mertsola J, Ramilo O, et al.: Increased endotoxin and interleukin-1B concentrations is cerebrospinal fluid of infants with coliform meningitis and ventriculitis associated with intraventricular gentamicin therapy. J Infect Dis 160:891–895, 1989.PubMedGoogle Scholar
  84. 84.
    Sande MA, Tauber MG, Scheid WM, et al.: Pathophysiology of bacterial meningitis: summary of the workshop. Pediatr Infect Dis J 8:929–933, 1989.PubMedGoogle Scholar
  85. 85.
    Gower DJ, Lewis JC, Kelly DL: Sterile shunt malfunction. A scanning electron microscopic perspective. J Neurosurg 61:1079–1084, 1984.PubMedGoogle Scholar
  86. 86.
    Bruni JE, Del Bigio MR: Reaction of periventricular tissue in the rat fourth ventricle to chronically placed shunt tubing implants. Neurosurgery 19:337–345, 1986.PubMedGoogle Scholar
  87. 87.
    Traynelis VC, Powell RG, Koss W, et al.: Cerebrospinal fluid eosinophilia and sterile shunt malfunction. Neurosurgery 23:645–649, 1988.PubMedGoogle Scholar
  88. 88.
    Oi S, Matsumoto S: Morphological findings of postshunt slit-ventricle in experimental canine hydrocephalus. Childs Nerv Syst 2:179–184, 1986.PubMedGoogle Scholar
  89. 89.
    Venes JL: Pleural fluid effusion and eosinophillia following ventriculopleural shunting. Pediatr Med Child Neurol 16:72–76, 1974.Google Scholar
  90. 90.
    Emery JL, Hilton HB: Lung and heart complications of treatment of hydrocephalus by ventriculoauriculostomy. Surgery 50:309–314, 1961.PubMedGoogle Scholar
  91. 91.
    Sperling DR, Patrick JR, Anderson FM, et al.: Cor pulmonale secondary to ventriculoauriculostomy. Am J Dis Child 107:308–315, 1964.PubMedGoogle Scholar
  92. 92.
    Nugent GR, Lucas R, Judy M, et al.: Thromboembolic complications of ventriculo-atrial shunts. Angiographie and pathologic correlations. J Neurosurg 24:34–42, 1966.PubMedGoogle Scholar
  93. 93.
    Forrest DM, Cooper DGW: Complications of ventriculo-atrial shunts. A review of 455 cases. J Neurosurg 29:506–512, 1968.Google Scholar
  94. 94.
    Rao PS, Molthan ME, Lipow HW: Cor pulmonale as a complication of ventriculoatrial shunts. Case report. J Neurosurg 33:221–225, 1970.PubMedGoogle Scholar
  95. 95.
    Lebel MH, Bishara JF, Syrogiannopoulos GA et al.: Dexamethasone therapy for bacterial meningitis: results of two double-blind, placebo-controlled trials. N Engl J Med 319:964–971, 1988.PubMedGoogle Scholar
  96. 96.
    Haines SJ, Nida TY: Treatment of multiloculated hydrocephalus. Childs Nerv Syst 6:280, 1990.Google Scholar
  97. 97.
    Powers SK: Fenestration of intraventricular cysts using a flexible, steerable endoscope and the argon laser. Neurosurgery 18:637–641, 1986.PubMedGoogle Scholar
  98. 98.
    Manwaring KH, Alexander S, Floyd W: Experience in intraventricular endoscopie microdissection utilizing the saline torch (abstract). Childs Nerv Syst 6:279, 1990.Google Scholar
  99. 99.
    Portnoy AD, Schulte RR, Croissant PD, et al.: Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing subdural hematoma. J Neurosurg 38:729–738,1973.PubMedGoogle Scholar
  100. 100.
    Horton D, Pollay M: Fluid flow performance of a new siphon-control device for ventricular shunts. J Neurosurg 72:926–932, 1990.PubMedGoogle Scholar
  101. 101.
    Foltz EL, Blanks JP: Symptomatic low intracranial pressure in shunted hydrocephalus. J Neurosurg 68:401–408, 1988.PubMedGoogle Scholar
  102. 102.
    Matsumae M, Sato O, Itoh K, et al.: Quantification of cerebrospinal fluid shunt flow rates: assessment of the programmable pressure valve. Childs Nerv Syst 5:356–360, 1989.PubMedGoogle Scholar
  103. 103.
    Lumenta CB, Roosen N, Dietrich U: Clinical experience with a pressure-adjustable valve SOPHY in the management of hydrocephalus. Childs Nerv Syst 6:270–274, 1990.PubMedGoogle Scholar
  104. 104.
    McCullough DC: Symptomatic progressive ventriculomegaly in hydrocéphalies with patent shunts and antisiphon devices. Neurosurgery 19:617–621, 1986.PubMedGoogle Scholar
  105. 105.
    Sainte-Rose C, Hooven MD, Hirsch JF: A new approach in the treatment of hydrocephalus. J Neurosurg 66:213–226, 1987.PubMedGoogle Scholar
  106. 106.
    Sainte-Rose C, Hirsch JF, Pierre-Kahn A, et al.: Flow-regulated device in the treatment of hydrocephalus (Abstract). Childs Nerv Syst 6:279–280, 1990.Google Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Enrique C. G. Ventureyra
  • Michael J. Higgins

There are no affiliations available

Personalised recommendations