Department of Neurosurgery, University of Washington Medical School, Seattle, Washington, USA.
Neurosurgery. 2012 Jan;70(1):E253-8; discussion E258. doi: 10.1227/NEU.0b013e31822abf95.
Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality.
A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size.
Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.
脑室非交通已在感染和急性颅内出血的情况下得到描述。我们描述了首例成人病例系列，这些患者在颅内后循环动脉瘤破裂后出现延迟性孤立性第四脑室，并确定了治疗方式。
对 2005 年至 2009 年期间在一家机构接受治疗的所有动脉瘤患者进行了回顾性研究。对显微手术闭塞和血管内病例均进行了查询。在此期间治疗的 1044 个动脉瘤中，有 3 名患者需要第四脑室分流术来治疗孤立性脑室。所有 3 例患者均接受了显微夹闭术夹闭动脉瘤，随后行额部脑室-腹腔脑脊液分流术。所有 3 例患者均无脑脊液感染的证据，这是通过连续培养来衡量的。随后，所有 3 例患者均出现延迟性症状，表现为扩张的第四脑室和脊髓空洞症或脊髓空洞。经探查或经皮穿刺证实了上腔分流的功能。然后，所有 3 例患者均通过使用低压分流系统进行第四脑室-腹腔脑脊液分流。分流后，所有 3 例患者的孤立性第四脑室相关症状迅速缓解。这种临床改善与第四脑室大小相关。
成人孤立性第四脑室是一种罕见现象，与接受显微夹闭术治疗的颅内后循环动脉瘤破裂有关。第四脑室-腹腔脑脊液分流术可有效缓解因被困脑室和相关脊髓空洞引起的症状。
