A disproportionately large communicating fourth ventricle treated by endoscopic third ventriculostomy: A case report

Abstract

A 59-year-old woman presented with ataxia, diplopia, and vomiting. She was transferred to our hospital after magnetic resonance imaging(MRI)showed hydrocephalus. Preoperative cine mode MRI showed a cerebrospinal fluid signal in the area of the fourth ventricle. Accordingly, hydrocephalus caused by occlusion of the foramina of Luschka and Magendie was considered. Observation of the affected ventricle using a neuroendoscope demonstrated many small polypoid lesions on the ventricle wall and ventriculography performed through the endoscopy showed the patency of the cerebral aqueduct and also revealed that contrast agent had stagnated in the fourth ventricle. We diagnosed a disproportionately large communicating fourth ventricle(DLCFV)and performed endoscopic third ventriculostomy. The postoperative course was uneventful, and all symptoms were resolved. Although the mechanisms underlying DLCFV remain unclear, neuroendoscopic observation and treatment may be useful. We report this case along with a review of the pertinent literature.