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Case Reports
. 2024 Dec;40(12):4389-4392.
doi: 10.1007/s00381-024-06645-9. Epub 2024 Nov 1.

Obstructive hydrocephalus of uncommon etiology: case report and neurosurgical management of aqueductal web presenting in adolescence

Aseel Masarwy  1 , Christopher Watterson  2 , Andre Boyke  1 , David Bonda  1 , Moise Danielpour  3
Affiliations
Case Reports

Obstructive hydrocephalus of uncommon etiology: case report and neurosurgical management of aqueductal web presenting in adolescence

Aseel Masarwy et al. Childs Nerv Syst. 2024 Dec.

Abstract

Introduction: Aqueductal webs are a rare cause of obstructive hydrocephalus. Accurate diagnosis and intervention can prevent neurological complications.

Case presentation: Herein, we describe a case of a child presenting with headaches and vomiting. Magnetic resonance imaging (MRI) revealed obstructive tri-ventricular hydrocephalus caused by an aqueductal web. Endoscopic third ventriculostomy (ETV) was successfully performed to restore cerebrospinal fluid (CSF) flow.

Conclusion: This case underscores the importance of phase-contrast and T2-weighted cinematic magnetic resonance imaging of cerebrospinal fluid flow for diagnosis of aqueductal webs. These modalities provide valuable insights into CSF dynamics and guidance of appropriate neurosurgical intervention.

Keywords: Endoscopic third ventriculostomy; Hydrocephalus; True-FISP MRI.

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Conflict of interest statement

Declarations. Ethics approval: A written informed consent was obtained from the patient’s parents for publication of the details of their medical case and any accompanying images. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A Sagittal T2 TSE image demonstrating aqueductal web. B Sagittal phase contrast, MAG sequence, showing the absence of flow across the cerebral aqueduct and 4th ventricle. Flow-related signal at the level of the foramen magnum may be muted due to upstream obstruction
Fig. 2
Fig. 2
Intra-operative image demonstrating aqueductal web
Fig. 3
Fig. 3
A Sag T2 TSE following surgery showing, black flow dephasing artifact as CSF crosses the ETV at the floor of the third ventricle. B Sag phase contrast, MAG sequence, showing white flow across the ETV and increased CSF flow about the foramen magnum. Retrograde flow into the 4th ventricle is now visualized
Fig. 4
Fig. 4
Sag T2 cine TrueFISP images demonstrate stability of the 3rd ventricular floor with pulsatile CSF flow across the patent ETV
See this image and copyright information in PMC

References

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