[Meningioma of the lateral ventricle (lateral choroid tela); value of conjugate paraclinical examinations: gamma-encephalogram, carotid and vertebral angiograms, pneumogram].
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Lateral ventricular tumors are rare lesions of the central nervous system, and because most tumors are benign or low grade, permanent cure can be achieved with complete removal. After adequate preoperative imaging discloses a lateral ventricular mass, the neurosurgeon has several options to choose from when determining the ideal surgical approach to the tumor. The surgical approach cannot be standardized, because the specific location, size, and vascularization of these deep-seated tumors are fundamental elements influencing the choice of surgical approach. Although access to the lateral ventricles may require additional preoperative considerations and planning, the combination of proper knowledge of the cortical and intraventricular anatomy with the familiarity and selection of an appropriate surgical approach will optimize the surgical outcome.
The hypothesis that benzodiazepine-induced hyperphagia is due to a specific enhancement of the palatability of foods has been supported by previous 'taste reactivity' studies of affective (hedonic and aversive) reactions to taste palatability. Diazepam and chlordiazepoxide enhance hedonic reactions of rats (rhythmic tongue protrusions, etc.) to sweet tastes in a receptor-specific fashion. A role for brainstem circuits has been indicated by a previous demonstration of the persistence of the taste reactivity enhancement by diazepam after midbrain decerebration. The present study examined whether benzodiazepine brainstem receptors are the chief substrates for palatability enhancement even in intact brains. We compared the effectiveness of benzodiazepine microinjections to elicit feeding and enhance hedonic reactions when delivered into either the lateral ventricle (forebrain) or the fourth ventricle (brainstem) of rats. The results show diazepam is reliably more effective at eliciting feeding and enhancing positive hedonic reactions to oral sucrose when microinjections are made in the fourth ventricle than in the lateral ventricle. We conclude that brainstem neural systems containing benzodiazepine-GABA receptors are likely to be the chief substrates for benzodiazepine-induced palatability enhancement.
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Tumours of the lateral ventricle in most cases enlarge significantly before signs and symptoms are exhibited. In the years between 1980 and 1991 we encountered 55 patients of all age groups with tumours of the lateral ventricle. All were diagnosed either by CT or MRI, and in lesions with good enhancement on CT additional angiography was performed. All 55 tumours were operated upon using microsurgical techniques. The approach was chosen according to the location of the tumour, preferably transcortical. In selected cases large tumours were removed in a two-stage operation. Only in one frontal horn and Cella media tumour an interhemispheric transcallosal approach was used. Postoperative or surgically related mortality was experienced in 3 cases. Life expectancy and morbidity were dependent upon histology.
Epidermoids occurring within the lateral ventricles are rare. At one time, they were regarded as anatomical curiosities. The lesions are of developmental aetiology, due to migration of epiblast inclusion at the time of formation of the cerebral vesicle. They are slow growing, and presentation is non-specific in the form of deteriorating mental functions. Generally seen in the fifth decade, but they have also been observed in the paediatric age group. MRI is suggestive of a cystic lesion, and is confirmed to be a typical epidermoid within the lateral ventricle at operation, often having a connection to the midline through the choroidal fissure. The cysts should be excised with no additional morbidity. Histopathology reveals typical stratified squamous epithelium.
Although lateral ventricle choroid plexus cysts in the second-trimester fetus have been considered a benign developmental phenomenon of no clinical significance, an association with trisomy 18 has been suggested. We designed a prospective study to determine whether karyotype analysis is indicated when such cysts are encountered on prenatal sonogram. During a 20-month period, 5400 low-risk pregnant women were examined sonographically in the second trimester to evaluate the prevalence of fetal lateral ventricle choroid plexus cysts and the incidence of ultrasonographic anomalies associated with such cysts in fetuses with trisomy 18 referred from cytogenetic laboratories. Thirty cases of fetal lateral ventricle choroid plexus cysts (0.6%) were detected during the study period; 28 newborns were normal and two had trisomy 18. One of the affected infants had other associated ultrasonographic abnormalities suggesting aneuploidy, whereas no detectable abnormalities could be found in the other. Three other pregnant women were referred to us from the cytogenetics services because fetal karyotype revealed trisomy 18; in all three cases lateral ventricle choroid plexus cysts and other sonographic abnormalities were observed. In total, we scanned five fetuses with trisomy 18, of which all had lateral ventricle choroid plexus cysts and four had associated detectable anomalies. We could not find any association between cyst size, number, or laterality and trisomy 18. In addition to the five cases of trisomy 18 described, we found 33 other fetuses reported with trisomy 18 in the second trimester; of this total, 25 (66%) had lateral ventricle choroid plexus cysts and 30% had no other detectable abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)
Isolation of the lateral ventricle has long been known to occur following ventriculitis. However, in recent years, functional isolation of the lateral ventricle has been seen with increasing frequency. Since 1979, eight patients without evidence of infection have required treatment for an isolated lateral ventricle following insertion of a contralateral ventriculoperitoneal shunt at the Hospital for Sick Children, Toronto, Ontario, Canada. Two of these patients developed their hydrocephalus after intraventricular hemorrhage, and in six patients the hydrocephalus was associated with myelodysplasia. We specifically excluded patients in whom isolation of the lateral ventricle was secondary to ventriculitis. We feel that the isolated lateral ventricle following ventriculoperitoneal shunting may be due to a dynamic situation where overdrainage of the shunted ventricle leads to a functional obliteration of the foramen of Monro and subsequent enlargement of the contralateral lateral ventricle.
BACKGROUND: Managing lesions situated in the atrium of the lateral ventricle remains a challenging neurosurgical problem. The purposes of this study were to examine the microsurgical anatomy of the atrium of the lateral ventricle and the optic radiation and to define the differences in the exposure obtained by various surgical approaches. METHODS: Fifteen adult cadaveric specimens were studied using magnification x3 to x40 after perfusion of the arteries and veins with colored silicone. The microsurgical anatomy of the atrium of the lateral ventricle was examined. The relationship between the optic radiation and the atrium was studied using the white matter fiber dissection technique. Surgical approaches to the atrium of the lateral ventricle were examined in stepwise dissection. RESULTS: The medial and inferior walls of the atrium were free from optic radiation fibers. Surgical approaches to the atrium of the lateral ventricle are divided into 3 routes: (1) anterior approach: transsylvian approach, (2) posterior approaches: posterior transcortical, posterior transcallosal, occipital, and supracerebellar transtentorial approaches, and (3) lateral approaches: transtemporal and subtemporal approaches. CONCLUSION: Knowledge of the microsurgical anatomy of the atrium of the lateral ventricle and surrounding vital structures and the choice of an appropriate surgical approach will help surgeons perform safe and minimally invasive surgery.
Cysticercosis cerebri involving the lateral ventricle is very rare. Two cases with such localization are presented. One of the patients, with occlusion of the foramen of Monro, was successfully treated by operation. A larval form in the lateral ventricle was revealed incidentally at autopsy in the second patient after rupture of a large basilar artery aneurysm.
The anatomy needed to plan microoperative approaches to the lateral ventricles was examined in 20 cadaveric cerebral hemispheres. The neural, arterial, and venous structures in the walls of the lateral ventricles and the relationship of the lateral ventricles to the third ventricle and basal cisterns were examined. The operative approaches to the lateral ventricle are reviewed.
Cranial computed tomography (CT) of 108 cases with dilated lateral ventricles was reviewed to elucidate the relationship between focal vulnerability of developing brain and disproportional dilatation of lateral ventricles. CT findings of 108 cases with symmetrical dilatation of lateral ventricles were classified into three types by morphometry of lateral ventricles: anterior horn predominant type (31 cases), diffuse type (36 cases), posterior horn predominant type (41 cases). Posterior horn predominant type has a tendency to occur in congenital anomalies and premature brain damage, and anterior horn predominant type in infantile brain damage. This disproportional dilatation of anterior or posterior horns suggests a vulnerability of periventricular structure in developing brain.
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Magnetic resonance (MR) imaging was performed on 21 presumed normal Beagle-type dogs. The size and symmetry of their lateral ventricles were evaluated and dogs were categorized on the basis of the percentage of their ventricular height (Vh) to brain height (Bh) and the ratio of the largest to the smallest ventricular area (rVA). Eleven dogs had lateral ventricles classified as normal sized (0-14% Vh/Bh) while 10 of 21 dogs had moderate enlargement (15-25% Vh/Bh) of one or both lateral ventricles. None of the dogs had severe lateral ventricular enlargement. Degree of asymmetry was also arbitrarily categorized on basis of rVA as normal to minimal (rVA < 1.5), mild (1.5 < rVA < 2.0), or severe (2.0 < rVA). Of the dogs having normal-sized lateral ventricles, six of eleven had symmetric, three of eleven had mildly asymmetric and two of eleven had severely asymmetric lateral ventricles. Of the dogs having at least one moderately enlarged lateral ventricles, five of ten had symmetric lateral ventricles, and two of ten had mild asymmetry and three of ten had severe asymmetry. Gender and body weight had no statistical relationship to lateral ventricle symmetry. Clinically insignificant ventricular enlargement and asymmetry was common in this group of Beagle dogs.
INTRODUCTION: After shunt insertion there is commonly a disproportionate reduction in size of the lateral ventricle containing the catheter (shunted lateral ventricle), which is almost certainly related to shunt function. To explore the difference between two shunt types, the Differential Pressure Medium Pressure cylindrical (M.P.) and Delta 1.5 valves (manufactured by P.S. Medical, Goleta, CA, USA), we measured lateral ventricle volumes preoperatively and after 3 months, using segmentation techniques on CT or MR scans. MATERIALS AND METHODS: There were 40 patients (mean age 65.7 months), 17 with M.P. and 23 with Delta valves. There were 22 new shunts (8 M.P. and 14 Delta), and 18 revisions (9 M.P. and 9 Delta). Shunted to non-shunted ventricle volume ratios and the difference in ratios (preoperative to 3 months) was calculated. A ratio considerably less than 1 would indicate disproportionate reduction in the volume of the shunted ventricle in comparison to the non-shunted one. RESULTS: In the new shunt group, the preoperative ratio was 1.63 for M.P. and 1.07 for Delta (p=0.148, one-way ANOVA). The 3-month ratio was 0.71 for M.P. and 1.44 for Delta. The difference in ratios was 0.91 for M.P. and -0.36 for Delta (p=0.042, one-way ANOVA). There were 4 shunt obstructions in this group (3 with M.P. and 1 with the Delta valve). In the revision group, the preoperative ratio was 0.85 for M.P. and 0.88 for Delta (p=0.859, one-way ANOVA). The 3-month ratio was 0.74 for M.P. and 0.60 for Delta. The difference in ratios was 0.11 for M.P. and 0.27 for Delta (p=0.274, one-way ANOVA). There were 5 shunt obstructions in this group (2 with M.P. and 3 with the Delta valve). No correlation was found between incidence of shunt obstruction and shunt type or ventricular volume ratio difference (preoperative to 3 months) in either of the two operation groups. CONCLUSIONS: Following new shunt insertion, the presence of a differential pressure valve results in early significant reduction in the shunted lateral ventricle volume. This may predispose to shunt obstruction although this study has not proven this. This effect was not observed with the Delta valve after 3 months. Following shunt revision, no difference between the two valve types was observed. This may indicate a chronic effect of the presence of a shunt on the ventricular system size, obviating the effect of different shunt types.
Colloid cyst is a relatively rare benign tumor which is usually found in the third ventricle. A patient who had a "colloid cyst" in his right lateral ventricle was experienced. A 33-year-old man had suffered from intermittent attacks of headache and vomiting for five months. On July 22, 1974, he was hospitalized to our clinic because of headache, memory and gait disturbance. At the time of admission his consciousness was clear but he had slight memory disturbance and urinary incontinence. Incipient papilledma was noted and the deep tendon reflexes of the lower extrimities were slightly accentuated. Lumbar puncture revealed a clear CSF and its pressure was within normal limit and the protein was 59 mg/dl. The plain skull films showed no abnormal findings. EEG showed an asymmetry of alpha-wave, and paroxysmal high voltage of slow wave was found in the right frontal area. Right cerebral angiography demonstrated an unrolling of the pericallosal arteries suggesting dilatation of the lateral ventricles. On the 9th hospital day, he suddenly began to complain of severe headache and became drowsy. Mannitol and hydrocortisone were injected intravenously without producing any remarkable effects. A ventricular drainage was done, and the patient recovered rapidly. A conray ventriculography revealed a round filling defect in the right lateral ventricle. A transventricular approach through a short linear incision in the right frontal cortex was preformed on the 25th hospital day. A cyst containing colloid substance, about 5x4 cm in size, was found to be attached to the medial wall of the right lateral ventricle anterior to the foramen of Monro. This cyst was almost completely removed. Histological findings revealed inner lining of epithelial cells, He died on the 25th postoperative day from bacterial meningitis. Autopsy confirmed the cyst to have originated from the right lateral ventricle. A review of the literature was made and the pathogenesis and diagnosis of this disease and the mechanism of development of the symptoms were discussed.
OBJECTIVE: To determine if an etiological difference exists between isolation of the lateral ventricle and isolation of the fourth ventricle after ventricular shunting. METHODS: Cases of symptomatic isolation of the lateral and fourth ventricles were reviewed retrospectively. The ages at presentation of ventricular isolation, the time course to development of isolation, the number of shunt surgeries leading up to symptomatic isolation, the types of shunt valves utilized, and the background of infection were analyzed. RESULTS: Twenty-six patients had lateral ventricle isolation and 11 patients had fourth ventricle isolation. Infection, hemorrhage, Chiari malformation/myelomeningocele, and aqueductal stenosis were factors contributing to hydrocephalus requiring treatment in these patients. Compared to 26.9% of patients with lateral ventricle isolation, 90.9% of patients with fourth ventricle isolation had a previous history of infection. CONCLUSIONS: Prior meningitis and ventriculitis frequently contributed to fourth ventricle isolation. Lateral ventricle isolation seems to arise from functional obstruction of the foramen of Monro related to prior shunting.