Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2015 Mar 23;2(2):72-75.
doi: 10.2176/nmccrj.2014-0245. eCollection 2015 Apr.

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Metin Orakdogen  1 , Selin Tural Emon  1 , Baris Erdogan  1 , Hakan Somay  1
Affiliations
Case Reports

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Metin Orakdogen et al. NMC Case Rep J. .

Abstract

We present four cases of hydrocephalus caused by occlusion of foramen of Magendie associated with Chiari Type I malformation and syringomyelia. The aim of this study is to evaluate the results of surgical treatment via fourth ventriculostomy with catheter from the fourth ventricle to the upper cervical subarachnoid space. Obstructive tetraventricular hydrocephalus due to occlusion of the foramina of Luschka and Magendie can be treated with cerebrospinal fluid shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, endoscopic third ventriculostomy, and endoscopic fourth ventriculostomy. Our aim was to solve all the pathologies such as Chiari malformation, hydrocephalus, and syringomyelia in one approach. Thus, the treatment consisted of posterior fossa decompression and exploration. All the patients were treated with suboccipital craniectomy and C1 laminectomy with excision of the membrane obstructing the foramen of Magendie. Fourth ventriculostomy with cathetering from fourth ventricle to upper cervical subarachnoid space was performed. The postoperative period was uneventful in all the patients. Neurological status of all the patients improved. Tetraventricular hydrocephalus and syrinx were reduced in the control cranial magnetic resonance imaging. Complications such as infection and catheter migration were not observed during the follow-up period. Treatment with fourth ventriculostomy using a catheter from fourth ventricle to upper cervical subarachnoid space could be a treatment of choice in cases with hydrocephalus caused by occlusion of the foramina of Magendie, with associated Chiari Type I malformation and syringomyelia.

Keywords: Chiari malformation; foramen of Magendie; tetraventricular hydrocephalus; ventriculostomy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Disclosure The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Figures

Fig. 1
Fig. 1
Cranial computed tomography shows fourth ventriculostomy with a catheter (white arrows).
Fig. 2
Fig. 2
Peroperative images. A: Occluded foramen of Magendie with transparent membrane (white arrow), B: Excised membrane and inside the fourth ventricle (white arrow), C: The catheter connecting the fourth ventricle to the cervical subarachnoid space, D: The catheter sutured to the arachnoid.
Fig. 3
Fig. 3
T2-weighted sagittal magnetic resonance imaging shows dilated fourth and lateral ventricle and syringomyelia preoperatively (A), reduced sizes of the ventricles and syringomyelia postoperatively (B).
Fig. 4
Fig. 4
T2-weighted sagittal magnetic resonance imaging shows dilated fourth ventricle and syringomyelia preoperatively (A), reduced sizes of the fourth ventricles and syringomyelia postoperatively (B).
See this image and copyright information in PMC

References

    1. Chai WX: Long-term results of fourth ventriculo-cisternostomy in complex versus simplex atresias of the fourth ventricle outlets. Acta Neurochir (Wien) 134: 27– 34, 1995. - PubMed
    1. Giannetti AV, Malheiros JA, da Silva MC: Fourth ventriculostomy: an alternative treatment for hydrocephalus due to atresia of the Magendie and Luschka foramina. J Neurosurg Pediatr 7: 152– 156, 2011. - PubMed
    1. Karachi C, Le Guérinel C, Brugières P, Melon E, Decq P: Hydrocephalus due to idiopathic stenosis of the foramina of Magendie and Luschka. Report of three cases. J Neurosurg 98: 897– 902, 2003. - PubMed
    1. Mohanty A, Biswas A, Satish S, Vollmer DG: Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction. Neurosurgery 63: 905– 913; discussion 913–914, 2008. - PubMed
    1. Rifkinson-Mann S, Sachdev VP, Huang YP: Congenital fourth ventricular midline outlet obstruction. Report of two cases. J Neurosurg 67: 595– 599, 1987. - PubMed

Publication types

LinkOut - more resources