J Korean Neurosurg Soc.  2015 Jan;57(1):68-71. 10.3340/jkns.2015.57.1.68.

Hydrocephalus due to Membranous Obstruction of Magendie's Foramen

• Kasapas K
• Varthalitis D
• Georgakoulias N
• Orphanidis G

• KMID: 2067096
• DOI: http://doi.org/10.3340/jkns.2015.57.1.68

Abstract

We report a case of non communicating hydrocephalus due to membranous obstruction of Magendie's foramen. A 37-year-old woman presented with intracranial hypertension symptoms caused by the occlusion of Magendie's foramen by a membrane probably due to arachnoiditis. As far as the patient's past medical history is concerned, an Epstein-Barr virus infectious mononucleosis was described. Fundoscopic examination revealed bilateral papilledema. Brain magnetic resonance imaging demonstrated a significant ventricular dilatation of all ventricles and turbulent flow of cerebelospinal fluid (CSF) in the fourth ventricle as well as back flow of CSF through the Monro's foramen to the lateral ventricles. The patient underwent a suboccipital craniotomy with C1 laminectomy. An occlusion of Magendie's foramen by a thickened membrane was recognized and it was incised and removed. We confirm the existence of hydrocephalus caused by fourth ventricle outflow obstruction by a membrane. The nature of this rare entity is difficult to demonstrate because of the complex morphology of the fourth ventricle. Treatment with surgical exploration and incision of the thickened membrane proved to be a reliable method of treatment without the necessity of endoscopic third ventriculostomy or catheter placement.

Keyword

Hydrocephalus; Magendie's foramen; Arachnoiditis; Obstruction

MeSH Terms

Adult
Arachnoid
Arachnoiditis
Brain
Catheters
Craniotomy
Dilatation
Female
Fourth Ventricle
Herpesvirus 4, Human
Humans
Hydrocephalus*
Infectious Mononucleosis
Intracranial Hypertension
Laminectomy
Lateral Ventricles
Magnetic Resonance Imaging
Membranes
Papilledema
Ventriculostomy

Figure

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  Fig. 1 A : Preoperative sagittal T2W TSE MRI showing turbulent flow of CSF in the fourth ventricle and back flow of CSF through the Monro's foramen to the lateral ventricles. B : Preoperative axial T2 MRI showing significant dilatation of fourth ventricle with turbulent flow of CSF. C : Preoperative axial T1 MRI showing dilatation of third, fourth and lateral ventricles. D : Preoperative axial T1 MRI showing significant dilatation of fourth ventricle. CSF : cerebelospinal fluid.

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  Fig. 2 A : Perioperative photo showing the occlusion of Magendie's foramen by the membrane. B : Perioperative photo showing Magendie's foramen after the incision and removal of the membrane.

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  Fig. 3 A : Postoperative sagittal T1 MRI showing marked decrease in the size of the ventricles. B : Postoperative coronal T1 MRI showing marked decrease in the size of the ventricles. C : Postoperative axial T1 MRI showing marked decrease in the size of the ventricles.

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