Tumours of the quadrigeminal plate and adjacent structures.
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We investigated the MR imaging appearance of flowing cerebrospinal fluid (CSF) in the brain in the presence of obstructive lesions of the ventricular pathways. The pulsatile movement of CSF through the ventricular system is seen as an area of low signal intensity that has been termed the CSF flow-void sign (CFVS). This is best appreciated in areas of narrowing within the ventricular system; that is, the aqueduct of Sylvius, foramen of Magendie, and interventricular foramina. MR studies of 27 patients with lesions affecting the ventricular pathways were reviewed for the presence of the CFVS. Single-echo T1-weighted and T2-weighted multisection techniques were used in all cases. The CFVS was always seen more prominently on the T2-weighted images. The presence of the CFVS indicated patency of the ventricular pathway in which it was identified. The absence of the CFVS in the presence of hydrocephalus indicated that a possible obstructive lesion was present, but it did not directly indicate the level of the obstruction. The CFVS was absent in the aqueduct of Sylvius in 13 patients with obstruction or stenosis of the aqueduct, but it was also absent in one patient with a colloid cyst of the interventricular foramina. In three patients with preoperative and postoperative MR, the CFVS was seen in the area of interest only after resection of the obstructing lesion. We concluded that the presence of the CFVS is a useful indicator of the patency of the ventricular pathway in which it is seen. The absence of the CFVS at a location in which it is normally seen may indicate the presence of an obstruction, but it must be correlated with other signs to be interpreted correctly.
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A review of vertebral and carotid angiograms in 59 cases of third ventricular pathology demonstrated that the anterior thalamoperforating arteries are affected primarily by obstructive dilatation of the third ventricle, dilatation of the third ventricle secondary to atrophy, intra third ventricular tumors, anterior and para third ventricular tumors, and hypothalamic and thalamic tumors. The posterior thalamoperforating arteries are affected primarily by midbrain atrophy, midbrain tumors, and thalamic tumors. The primary and secondary effects have been outlined. Understanding of the anatomy of the thalamoperforating arteries facilitates localization of the site of obstruction in hydrocephalus, helps differentiate obstructive hydrocephalus from ventricular dilatation secondary to atrophy, permits differentiation between tumoral and non-tumoral dilatation of the third ventricle, aids in the diagnosis and differential diagnosis of intra third and para third ventricular masses including their posterior extent, and facilitates the diagnosis of thalamic, hypothalamic, and midbrain tumors.
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