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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The fourth ventricle is rhomboid in shape and is at its widest in the region of the junction between the medulla and pons. Nuclei of the vagus and other cranial nerves are located below the fourth ventricle, some of which may be identified using appropriate staining techniques. The postrema is an area where the blood-brain barrier is absent. It forms the most caudal aspect of the floor of the fourth ventricle. It is also the site of action of emetics. The fourth ventricle narrows superiorly and becomes the narrow cerebral aqueduct, which passes throughout the length of the midbrain. A small lateral aperture at the widest part of the fourth ventricle (also known as the foramen of Luschka) allows CSF to pass out into the subarachnoid space.
Neurosurgical Techniques and Strategies
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Jonathan E. Martin, Ian F. Pollack, Robert F. Keating
In the overwhelming majority of patients, obstruction of spinal fluid pathways at the level of the cerebral aqueduct or fourth ventricle results in hydrocephalus. Less commonly, elevated CSF protein from hemorrhage or leptomeningeal disease may result in impaired absorption of spinal fluid at the level of arachnoid granulations. Although uncommon, overproduction of spinal fluid from choroid plexus tumors may result in hydrocephalus. Treatment of hydrocephalus can proceed along one of three pathways depending on the presenting exam and anatomy of the patient.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The peduncles are further divided by a pigmented lamina called substantia nigra into a dorsal tegmentum and ventral crus cerebri. The tegmenti are continuous across the midline, but the crura are separate. The cerebral aqueduct lies between the tectum and tegmentum, and connects the third and the fourth ventricles. The optic tracts wind around the midbrain at its junction with the diencephalon. The oculomotor nerve (III) emerges from the medial surface of the peduncle. Lateral to the midbrain is the uncus of the temporal lobe.
Tectal region papillary neuroglial tumour: a case report
Published in British Journal of Neurosurgery, 2023
Paul Page, Jennifer Meylor, Yiping Li, Viharkumar Patel, Azam Ahmed
Using navigation guidance, an occipital ventriculostomy was placed during the initial portions of the craniotomy after turning the bone flap and opening the dura prior to continuing the approach dissection. This was to allow for CSF drainage and retraction. After careful microsurgical dissection through an occipital transtentorial approach, inspection demonstrated the tumor arising from the area of the right inferior colliculus. Operatively the mass appeared as a well circumscribed expanded hyper-vascular mass that appeared to be gliotic and necrotic in nature. After circumferential dissection, the mass was internally debulked and resected. Resection was carried anteriorly until the cerebral aqueduct was exposed. An external ventricular drain was left in place at the conclusion of the case.
A rare case of intralesional haemorrhage of a benign aqueductal cyst after CSF diversion treatment. A case report and review of literature
Published in British Journal of Neurosurgery, 2023
R. D. Biju, J. O’ Sullivan, A. Thomas, P. Gan, T. Muthu
The natural history of benign ventricular cysts is poorly understood.5,6 Colloid cysts are rare, representing about 0.5–1% of all intracranial tumours.7,8 Preferentially encountered within the third ventricle, other locations have been reported including the fourth ventricle, suprasellar region, cerebellum and rarely, within the cerebral aqueduct.9 They are not typically vascular in nature, making intracystic haemorrhage a rare phenomenon. About 21 cases have been reported in literature worldwide, 4 of which were at post-mortem.10,11 Cuoco et al. hypothesized that an exercise-induced rise in systolic blood pressure contributed to the phenomena in their 21-year-old patient.12 Spontaneous intracystic haemorrhage in pineal cysts is a well-documented phenomenon. Tamura et al. described its occurrence in their patient who commenced antiplatelet treatment for stroke.13,14
Coats plus in prematurity
Published in Ophthalmic Genetics, 2022
Ashley López-Cañizares, Maria P. Fernandez, Hasenin Al-Khersan, Piero Carletti, Monica S Arroyo, Maria C Fernandez-Ruiz, Audina M Berrocal
At this juncture, given the established family history along with the atypical behavior of Patient 1ʹs retinopathy, and his complex medical history, the case was discussed with the pediatric neurologist, and neuroimaging was recommended. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain demonstrated bilateral calcifications involving the gray-white matter interface, thalami, and bilateral basal ganglia. Disease involvement of the quadrigeminal plate, which appeared thickened and irregular, was associated with narrowing of the cerebral aqueduct and obstructive hydrocephalus, with mild-to-moderate dilatation of the lateral and third ventricles. Genetic testing was then pursued, which revealed two heterozygous pathogenic mutations in the CTC1 gene: c.2954_2956del (p.Cys985del) and c.859C>T (p.Arg287), confirming the diagnosis of Coats Plus syndrome in Patient 1 as well.