Sato Shinya, Sonoda Yukihiko, Kuroki Ryo, Kayama Takamasa
Department of Neurosurgery, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 9909585, Japan.
No To Shinkei. 2004 Dec;56(12):1042-6.
Aqueductal stenosis is induced by widely various causes. These causes include congenital stenosis, tumor or inflammation. Among them vascular malformation is a very rare cause. In this paper we present a rare case of aqueductal stenosis caused by venous angioma. The patient was a 28-year-old female, who suffered from headache and double vision. On admission, CT and MRI showed lateral and third ventricular dilatation not but fourth ventricle, suggested aqueductal stenosis. Gd-DTPA enhanced T1-weighted MR image showed an abnormal draining vein passing through the orifice of the aqueduct. Angiography demonstrated the umbrella sign which was specific sign of the venous angioma. We performed endoscopic third ventriculostomy. Postoperative neuroradiological examination showed shrinkage of the ventricles and the symptom of the patient improved markedly. In the past literatures, five cases of aqueductal stenosis due to venous angioma have been reported. Although venous angioma is congenital, all five cases had been symptomatic at adult stage. Detailed evaluation of pre-and post-operative MRIs suggest that aqueductal stenosis induced enlargement of the lateral and third ventricles, which led narrowing of the suprachiasmatic cistern and the peri-mesencephalic cistern, and downward displacement of medulla and tonsil into the foramen magnum. As a result, hydrocephalus is aggravated gradually.
导水管狭窄由多种原因引起。这些原因包括先天性狭窄、肿瘤或炎症。其中血管畸形是一种非常罕见的原因。在本文中，我们报告了一例由静脉血管瘤引起的罕见导水管狭窄病例。患者为一名28岁女性，有头痛和复视症状。入院时，CT和MRI显示侧脑室和第三脑室扩张，但第四脑室未扩张，提示导水管狭窄。钆喷酸葡胺增强T1加权磁共振图像显示一条异常引流静脉穿过导水管口。血管造影显示了静脉血管瘤的特异性征象——伞征。我们进行了内镜下第三脑室造瘘术。术后神经影像学检查显示脑室缩小，患者症状明显改善。在过去的文献中，已报道了5例因静脉血管瘤导致的导水管狭窄病例。尽管静脉血管瘤是先天性的，但所有5例在成年期均出现症状。术前和术后MRI的详细评估表明，导水管狭窄导致侧脑室和第三脑室扩大，进而导致视交叉上池和中脑周围池变窄，延髓和扁桃体向下移位至枕骨大孔。结果，脑积水逐渐加重。
