Cerebral Ventricles ; Heart Ventricles ; Humans ; Punctures

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

Hydrocephalus is a common neurological disease with complex etiology. It is characterized by the accumulation and continuous growth of cerebrospinal fluid in the ventricular system and subarachnoid space. Hydrocephalus can be caused by congenital genetic factors, brain trauma and cerebral hemorrhage. Through the efforts of many researchers, the pathogenesis of hydrocephalus is being completed, but it has not been fully explained. The imbalance of cerebrospinal fluid production and absorption into the sinus, and disorder of the cerebrospinal fluid circulation pathway or the osmotic pressure maintenance in the ventricle can lead to increased cerebrospinal fluid and ventricular dilatation.
Cerebral Hemorrhage ; Cerebral Ventricles ; Cerebrospinal Fluid ; Humans ; Hydrocephalus

Microglia play a key role in the immune response and inflammatory reaction that occurs in response to ischemic stroke. Activated microglia promote neuronal damage or protection in injured brain tissue. Extracellular signals polarize the microglia towards the M1/M2 phenotype. The M1/M2 phenotype microglia released pro- and anti-inflammatory cytokines which induce the activation of neural stem/progenitor cells (NSPCs). In this study, we investigated how the cytokines released by microglia affect the activation of NSPCs. First, we treated BV2 cells with a lipopolysaccharide (LPS; 20 ng/ml) for M1 phenotype microglia and interleukin-4 (IL-4; 20 ng/ml) for M2 phenotype microglia in BV2 cells. Mice were subjected to transient middle cerebral artery occlusion (tMCAO) for 1 h. In ex vivo, brain sections containing the subventricular zone (SVZ) were cultured in conditioned media of M1 and M2 phenotype-conditioned media for 3 d. We measured the expression of cytokines in the conditioned media by RT-PCR and ELISA. The M2 phenotype microglia-conditioned media led to the proliferation and neural differentiation of NSPCs in the ipsilateral SVZ after ischemic stroke. The RT-PCR and ELISA results showed that the expression of TGF-α mRNA was significantly higher in the M2 phenotype microglia-conditioned media. These data support that M2 phenotype microglia-derived TGF-α is one of the key factors to enhance proliferation and neural differntiation of NSPCs after ischemic stroke.
Animals ; Brain* ; Culture Media, Conditioned ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Infarction, Middle Cerebral Artery ; Interleukin-4 ; Lateral Ventricles ; Mice ; Microglia ; Neurons* ; Phenotype* ; RNA, Messenger ; Stem Cells* ; Stroke

We report a rare case of subependymal giant cell astrocytoma (SEGA) associated with tumoral bleeding in a pediatric patient without tuberous sclerosis complex (TSC). A 10-year-old girl presented with a 2-week history of an increasingly aggravating headache. Brain magnetic resonance imaging revealed an approximately 3.6-cm, well-defined, heterogeneously enhancing mass with multistage hemorrhages on the right-sided foramen of Monro. The tumor was completely resected using a transcallosal approach. Intraoperatively, the mass presented as a gray-colored firm tumor associated with acute and subacute hemorrhages. The origin of the mass was identified as the ventricular septum adjacent to the foramen of Monro. A pathological analysis revealed pleomorphic multinucleated eosinophilic tumor cells with abundant cytoplasm. These cells showed positive staining for the glial fibrillary acidic protein and S100 protein. A diagnosis of SEGA was established. The patient recovered without any neurological symptoms. There was no evidence of TSC. The radiological follow-up showed no recurrence for 2 years. This was a case of SEGA with intratumoral hemorrhage, for which a favorable outcome was achieved, without any neurological deficit after tumoral resection.
Astrocytoma* ; Brain ; Cerebral Ventricles ; Child ; Cytoplasm ; Diagnosis ; Eosinophils ; Female ; Follow-Up Studies ; Glial Fibrillary Acidic Protein ; Headache ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Recurrence ; Tuberous Sclerosis ; Ventricular Septum

OBJECTIVE: An adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated. METHODS: The coronal adjustment angle from the orthogonal catheter trajectory at Kocher's point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central 0° line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans. RESULTS: For the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 (mean±standard deviation [SD]: 0.27±0.03) and the adjustment angle ranged from 0° to 10° (mean±SD: 5.2°±3.2°). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications. CONCLUSION: The proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher’s point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.
Animals ; Catheterization ; Catheters* ; Cerebral Ventricles ; Cerebrospinal Fluid ; Head ; Hemorrhage ; Horns ; Humans ; Hydrocephalus ; Incidence ; Pilot Projects* ; Ventriculoperitoneal Shunt

BACKGROUND: Ventriculitis is a rare and critical infection of the central nervous system. Here, we report a case of ventriculitis by extended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae , after acupuncture at the low back. CASE REPORT: A 72-year-old woman visited our center with fever, headache, and decreased mental status, after undergoing low back acupuncture. Brain imaging showed the fluid-debris level in the lateral ventricle, suggesting ventriculitis. ESBL producing Klebsiella pneumoniae were cultured from the cerebrospinal fluid. After the administration of antibiotics, although the ventriculitis was treated, the quadriplegia remained. CONCLUSIONS: This case stresses the importance of aseptic techniques during acupuncture.
Acupuncture ; Aged ; Anti-Bacterial Agents ; beta-Lactamases ; Central Nervous System ; Cerebral Ventriculitis ; Cerebrospinal Fluid ; Female ; Fever ; Headache ; Humans ; Klebsiella pneumoniae ; Klebsiella ; Lateral Ventricles ; Neuroimaging ; Quadriplegia

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

A variety of surgical approaches to temporal horn tumors of the lateral ventricle have been described. Magnetic resonance imaging (MRI) and angiography are the preferred modalities for preoperative evaluation and provide important information for the choice of surgical approach. A 59-year-old man was referred to our hospital due to confusion and gait disturbance. On enhanced MRI, a homogeneous enhanced solitary mass was observed within the temporal horn of the left lateral ventricle with transependymal extension. The lesion was accompanied by increased hypervascular tumor blush on preoperative cerebral angiography. Subtotal removal of the temporal horn tumor was performed because the lesion was identified as lymphoma during surgery. The postoperative course was un-eventful. The patient was referred to the oncology department for conventional chemotherapy. Adjuvant chemotherapy improved the clinical outcome. The pterional-transsylvian approach was beneficial for partial removal of the tumor and tissue diagnosis in this case.
Angiography ; Animals ; Cerebral Angiography ; Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Gait ; Horns* ; Humans ; Lateral Ventricles ; Lymphoma ; Magnetic Resonance Imaging ; Middle Aged

In this study, we reviewed the clinical characteristics of five cases of subependymal giant cell astrocytoma (SEGA) at our hospital between May 1997 and July 2012. The median age was 18 years old (range, 8 to 26). The clinical symptoms were presented as seizure in two patients and headache in three patients. All the tumors were located near the foramen of Monro. The median size of the tumors was 2.5 cm (range, 1.9-4.0). Two patients showed the solitary lesion, and three had subependymal nodules and cortical tubers. The median follow-up duration was 7.4 years (range, 2.0-14.3). Three patients were associated with the tuberous sclerosis complex (TSC). Four patients showed the SEGA at the first presentation and one patient experienced the 1.9 cm-sized growing mass during 7.7 years follow-up after the diagnosis of the TSC. The mass was totally removed in four patients and subtotally in one. Postoperatively, one patient took the medication for the seizure, which was controllable. The subtotally removed mass showed the recurrence postoperative 4.1 years later, and the recurred mass was stable for 4.5 years after the recurrence. The clinical follow-up study of the SEGA showed an indolent behavior before and after the surgery.
Astrocytoma* ; Cerebral Ventricles ; Diagnosis ; Follow-Up Studies ; Headache ; Humans ; Neurosurgery ; Recurrence ; Seizures ; Tuberous Sclerosis