Choroid plexus papilloma(CPP) is a rare intraventricular neoplasm occurring primarily in the lateral ventricle of children and the 4th ventricle of adults. The 3rd ventricle is an extremely rare site for CPP to occur. The authors report two cases of CPP of the 3rd ventricle in a 2-month-old girl and a 4-month-old boy, and one case of CPP of the 4th ventricle in a 17-year-old male. Two CPP of third ventricle were totally removed by transcortical-transventricular approach and transcallosal subchoroidal approach, respectively. The CPP in the fourth ventricle was totally removed by suboccipital approach. The subdural hygroma and hydrocephalus due to CSF overproduction was managed with subduroperitoneal shunt and ventriculoperitoneal shunt.
Adolescent ; Adult ; Cerebral Ventricle Neoplasms ; Child ; Choroid Plexus* ; Choroid* ; Female ; Fourth Ventricle* ; Humans ; Hydrocephalus ; Infant ; Lateral Ventricles ; Male ; Papilloma, Choroid Plexus* ; Subdural Effusion ; Third Ventricle ; Ventriculoperitoneal Shunt

The computed tomographic findings in 5 patients with the central neurofibromatosis were reviewed. Atypical choroid plexus calcification was evident in 3 of 5 patients in the anterior half of lateral ventricle, foramen of Monro and third ventricle. The cause of this abnormal calcification is unknown yet, but it may have the diagnostic significance for central neurofibromatosis.
Cerebral Ventricles ; Choroid Plexus* ; Choroid* ; Humans ; Lateral Ventricles ; Neurofibromatosis 2* ; Third Ventricle

Central neurocytoma, a cerebral intraventricular tumor, is usually benign. It frequently develops in the area of the foramen of Monro, and is usually attached to the septum pellucidum. Mild to moderate contrast enhancement is common. We encountered a case of central neurocytoma in a 60-year-old woman; the tumor arose from the atrium of the lateral ventricle, and extraventricular extension and malignant transformation were apparent. CT and MRI revealed a well-defined, slightly heterogeneous mass measuring 2.5x3x5cm with surrounding edema. There was strong contrast enhancement of the mass.
Cerebral Ventricles ; Edema ; Female ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging ; Middle Aged ; Neurocytoma* ; Septum Pellucidum

Chordoid glioma is a rare low grade tumor typically located in the third ventricle. Although a chordoid glioma can arise from ventricle with tumor cells having features of ependymal differentiation, intraventricular dissemination has not been reported. Here we report a case of a patient with third ventricular chordoid glioma and intraventricular dissemination in the lateral and fourth ventricles. We described the perfusion MR imaging features of our case different from a previous report.
Adult ; Cerebral Ventricle Neoplasms/diagnosis/pathology/*secondary ; Fourth Ventricle/*pathology ; Glioma/diagnosis/*pathology ; Humans ; Lateral Ventricles/*pathology ; Magnetic Resonance Imaging/methods ; Male ; Third Ventricle/*pathology

Inflammatory pseudotumor is an uncommon lesion with unknown etiology characterized by sclerosing inflammation which clinically and radiographically mimics a neoplastic lesion. A 47-year-old man presented with sudden headache and dysarthria. Brain CT scan revealed a 2.6x2.2 cm sized, round, and hyperdense mass in the anterolateral wall of the left lateral ventricular trigone. On MR imaging studies, the mass showed low signal intensity in the wall of the trigone on T2-weighted image, central mixed (iso- and high-) signal intensity with peripheral low-signal intensity on T1-weighted image. Subtle staining of left choroid plexus with irregular shaped distal branch of anterior choroidal artery was found on the cerebral angiography. These findings suggested a small tumorous lesion originated from the left choroid plexus. During the hospital days, the mass manifested as repeated hemorrhages. The mass was successfully removed via left occipital transcortical approach. The histopathological report of the specimen was hemorrhage and fibrosis, with dense lymphoplasma cell infiltration, suggestive of an inflammatory pseudotumor.
Arteries ; Brain ; Cerebral Angiography ; Choroid ; Choroid Plexus ; Dysarthria ; Fibrosis ; Granuloma, Plasma Cell ; Headache ; Hemorrhage ; Humans ; Inflammation ; Lateral Ventricles ; Middle Aged

The authors report a unique case of unilateral Moyamoya disease with a rare combination of arteriovenous malformation (AVM) who presented with intracerebral hemorrhage (ICH). A 50-year-old man suffered from sudden onset of mental deterioration and right hemiparesis. Brain computed tomography (CT) showed intracerebral hemorrhage on left thalamus. Brain CT angiography and cerebral digital subtraction angiography (DSA) revealed AVM combined with unilateral moyamoya disease involving left middle cerebral artery (MCA) and choroid plexus in left lateral ventricle. Intraventricular hemorrhage and hydrocephalus were managed conservatively. A rare case of unilateral Moyamoya disease accompanied by a cerebral arteriovenous malformation is described and discussed with review of pertinent literature.
Angiography ; Angiography, Digital Subtraction ; Arteriovenous Malformations* ; Brain ; Cerebral Hemorrhage ; Choroid Plexus ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Arteriovenous Malformations ; Lateral Ventricles ; Middle Aged ; Middle Cerebral Artery ; Moyamoya Disease* ; Paresis ; Thalamus

A 35-year-old female visited emergency department for a sudden onset of headache with vomiting after management for abortion at local department. Neurological examination revealed drowsy mentality without focal neurological deficits. CT showed 3.2×3.4 cm hyperdense intraventricular mass with intraventricular hemorrhage. The intraventricular hemorrhage was found in lateral, 3rd, and 4th ventricles. MRI showed well enhancing intraventricular mass abutting choroid plexus in the trigone of the right lateral ventricle. CT angiography showed tortuous prominent arteries from choroidal artery in tumor. Her neurological status deteriorated to stupor and contralateral hemiparesis during planned preoperative workup. Urgent transtemporal and transcortical approach with decompressive craniectomy for removal of intraventricular meningioma with hemorrhage was done. Grossly total removal of ventricular mass was achieved. Pathological finding was meningotheliomatous meningioma of World Health Organization (WHO) grade I. The patient recovered to alert mentality and no motor deficit after intensive care for increased intracranial pressure. However, visual field defect was developed due to posterior cerebral artery territory infarction. The visual deficit did not resolve during follow up period. Lateral ventricular meningioma with spontaneous intraventricular hemorrhage in pregnant woman is very uncommon. We report a surgical case of lateral ventricular meningioma with rapid neurological deterioration for intraventricular hemorrhage.
Adult ; Angiography ; Arteries ; Choroid ; Choroid Plexus ; Critical Care ; Decompressive Craniectomy ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Fourth Ventricle ; Headache ; Hemorrhage ; Humans ; Infarction ; Intracranial Pressure ; Lateral Ventricles ; Magnetic Resonance Imaging ; Meningioma ; Neurologic Examination ; Paresis ; Posterior Cerebral Artery ; Pregnancy ; Pregnant Women ; Stupor ; Visual Fields ; Vomiting ; World Health Organization

OBJECTIVE: External ventricular drain (EVD) is commonly performed with a freehand technique using surface anatomical landmarks at two different cranial sites, Kocher's point and the forehead. The aim of this study was to evaluate and compare the accuracy and safety of these percutaneous ventriculostomies. METHODS: A retrospectively review of medical records and head computed tomography scans were examined in 227 patients who underwent 250 freehand pass ventriculostomy catheter placements using two different methods at two institutions, between 2003 and 2009. Eighty-one patients underwent 101 ventriculostomies using Kocher's point (group 1), whereas 146 patients underwent 149 forehead ventriculostomies (group 2). RESULTS: In group 1, the catheter tip was optimally placed in either the ipsilateral frontal horn or the third ventricle, through the foramen of Monro (grade 1) in 82 (81.1%) procedures, in the contralateral lateral ventricle (grade 2) in 4 (3.9%), and into eloquent structures or non-target cerebrospinal space (grade 3) in 15 (14.8%). Intracerebral hemorrhage (ICH) >1 mL developed in 5 (5.0%) procedures. Significantly higher incidences of optimal catheter placements were observed in group 2. ICH>1 mL developed in 11 (7.4%) procedures in group 2, showing no significant difference between groups. In addition, the mean interval from the EVD to ventriculoperitoneal shunt was shorter in group 2 than in group 1, and the incidence of EVD-related infection was decreased in group 2. CONCLUSION: Accurate and safe ventriculostomies were achieved using both cranial sites, Kocher's point and the forehead. However, the forehead ventriculostomies provided more accurate ventricular punctures.
Animals ; Catheters ; Cerebral Hemorrhage ; Cerebral Ventricles ; Forehead ; Head ; Horns ; Humans ; Hydrocephalus ; Incidence ; Lateral Ventricles ; Medical Records ; Punctures ; Retrospective Studies ; Third Ventricle ; Ventriculoperitoneal Shunt ; Ventriculostomy

Focal ventricular dilatation of the temporal horn caused by an occlusion of the cerebrospinal fluid pathway at the atrium of the lateral ventricle is a form of non communicating hydrocephalus, and this condition is termed as "entrapment of the temporal horn". The choroid plexus is important central nervous system(CNS) structure, but it is often neglected in pathologic and clinical studies of intracranial diseases. Even though choroid plexitis is very rare, it may be occurred as the resultant of CNS infections and primary choroid plexitis can be associated with bacterial, viral, and parasitic etiologies. Some aspects of the neuroimaging findings of this infection mimick those of a intraventricular neoplasms. The most important neoplasms which should be differentiated, are choroid plexus papilloma and carcinoma. Wherem primary neoplasms of the choroid plexus are well known, but primary infections of the choroid plexus (such as choroid plexitis) are not commonly encountered. Pseudomonas stutzeri infections are especially rare as the causative organism of the choroid plexitis and often have serious underlying disease but generally respond well to treatment with antibiotics. We report a 65-year-old female patient with primary choroid plexitis due to Pseudomonas stutzeri and the findings of her brain computerized tomography and magnetic resonance imaging. In conclusion, our case revealed that choroid plexitis may result in ventricular entrapment and mimick intraventricular tumors. Although it is very rare, when a intraventricular mass was observed in imaging studies and combined with signs and symptoms suggesting CNS infection, choroid plexitis should be considered.
Aged ; Animals ; Anti-Bacterial Agents ; Brain ; Cerebral Ventricle Neoplasms ; Cerebrospinal Fluid ; Choroid Plexus ; Choroid* ; Dilatation ; Female ; Horns* ; Humans ; Hydrocephalus ; Lateral Ventricles* ; Magnetic Resonance Imaging ; Neuroimaging ; Papilloma, Choroid Plexus ; Pseudomonas stutzeri* ; Pseudomonas*

CT is a new non-invasive diagnostic imaging method, which has ability to differentiate D.S.F., hematoma, and even edematous brain from normal brain tissue. Prior to the introduction of the CT, the diagnosis of the intraventricular hemorrhage in living patients was difficult and was confirmed by surgery or autopsy. Intracranial hemorrhages are visible on the CT with density higher than brain tissue in acute phase. CT is an accurate method for detecting of intraventricular hemorrhage including detection of nature, location, amount, and associated changes. CT is also useful as a surgical guidance and in the evaluation of fate of the hematomas by easily performable follow up studies. The causes of the intraventricular hemorrhages are hypertension, rupture of aneurysm, arteriovenous malformation, head trauma, brain tumor, and others. This study included evaluation of CT of 69 patients who show the high density in cerebral ventricular system during the period of 31 months fromFeb.1979 to Aug. 1981 in the department of radiology, college of medicine, Hanyang University. The results were as follows. 1. Age distribution of the total 69 patients was broad ranging from 1 month to 80 years. 28% of patients were in the 6th decade. The male to female ratio was 2:1. 2. The consciousness of patients at CT study: Those were conscious in 11 cases, stuporous in 41 cases and unconscious in 17 cases. 3. The causes of intraventricular hemorrhages were hypertension in 28 cases, head trauma in 12 cases, aneurysm in 4 cases, tumor in 2 cases and others in 23 cases. 4. 9 cases showed intraventricular hematomas only, other 60 cases showed associated intracranial hematomas: Those were intracerebral hematomas in 53 cases including 30 cases of basal ganglial & thalamic hematomas, subarachnoid hemorrhages in 17 cases, epidural hematomas in 3 cases, and subdural hematomas in2 cases. 5. All cases of the intraventricular hematomas except one showed hematoma in the lateral ventricles, hematomas in the 3rd ventricle in 35 cases, and hematomas in the 4th ventricle in 29 cases. 6. 28 out of 69 cases showed dilatation of the lateral ventricles. 7. Only 8 out of 69 cases were improved remarkably, 11 cases were slightly improved, and 48 cases were expired. The overall mortality was 70%. 8. The consciousness of the patient at the CT study and possibly the associated intracerbral hematoma play an important role in mortality. The age of the patients, causes of hemorrhages, presence of ventricular dilatation, and methods of treatment did not affect the mortality.
Age Distribution ; Aneurysm ; Arteriovenous Fistula ; Autopsy ; Brain ; Brain Neoplasms ; Cerebral Ventricles ; Consciousness ; Craniocerebral Trauma ; Diagnosis ; Diagnostic Imaging ; Dilatation ; Female ; Follow-Up Studies ; Fourth Ventricle ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhages ; Lateral Ventricles ; Male ; Methods ; Mortality ; Rupture ; Stupor ; Subarachnoid Hemorrhage ; Third Ventricle