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. 2011 Jan;258(1):44-9.
doi: 10.1007/s00415-010-5678-1. Epub 2010 Aug 3.

Size of third and fourth ventricle in obstructive and communicating acute hydrocephalus after aneurysmal subarachnoid hemorrhage

D S Knol  1 , J van Gijn, C L J J Kruitwagen, G J E Rinkel
Affiliations

Size of third and fourth ventricle in obstructive and communicating acute hydrocephalus after aneurysmal subarachnoid hemorrhage

D S Knol et al. J Neurol. 2011 Jan.

Abstract

In patients with acute hydrocephalus after aneurysmal subarachnoid haemorrhage (SAH), lumbar drainage is possible if the obstruction is in the subarachnoid space (communicating hydrocephalus). In case of intraventricular obstruction (obstructive hydrocephalus), ventricular drainage is the only option. A small fourth ventricle is often considered a sign of obstructive hydrocephalus. We investigated whether the absolute or relative size of the fourth ventricle can indeed distinguish between these two types of hydrocephalus. On CT-scans of 76 consecutive patients with acute headache but normal CT and CSF, we measured the cross-sectional surface of the third and fourth ventricle to obtain normal planimetric values. Subsequently we performed the same measurements on 117 consecutive SAH patients with acute hydrocephalus. These patients were divided according to the distribution of blood on CT-scan into three groups: mainly intraventricular blood (n=15), mainly subarachnoid blood (n=54) and both intraventricular and subarachnoid blood (n=48). The size of the fourth ventricle exceeded the upper limit of normal in 2 of the 6 (33%) patients with intraventricular blood but without haematocephalus, and in 15 of the 54 (28%) patients with mainly subarachnoid blood. The mean ratio between the third and fourth ventricle was 1.45 (SD 0.66) in patients with intraventricular blood and 1.42 (SD 0.91) in those with mainly subarachnoid blood. Neither fourth ventricular size nor the ratio between the third and fourth ventricles discriminates between the two groups. A small fourth ventricle does not necessarily accompany obstructive hydrocephalus and is therefore not a contraindication for lumbar drainage.

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Figures

Fig. 1
Fig. 1
Example of each of the three groups in which patients with acute hydrocephalus after aneurysmal haemorrhage were categorised
Fig. 2
Fig. 2
Graphs showing the distribution of the size (maximal cross-sectional area in the axial plane in mm2) of the third ventricle (upper panel) and fourth ventricle (lower panel) in 76 controls, as measured on computed tomography scanning
Fig. 3
Fig. 3
Graphs showing the distribution of sizes of the third ventricle (a) and fourth ventricle (b), in mm2 (maximal cross-sectional surface), according to the site of obstruction (within the ventricular system or in the subarachnoid space), in 69 patients with acute dilatation of the lateral ventricles after SAH. Value for ventricles in which the cavity was completely filled (and probably expanded) by blood are represented by triangles instead of circles. The horizontal line represents the upper limit of normal
See this image and copyright information in PMC

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