Additionally, AMs were injected into the third and fourth ventricles of conscious eels to assess their site of dipsogenic action. AM2 and ANG II injected into the third ventricle increased arterial pressure, while AM5 decreased it in a dose-dependent manner, and both AM2 and AM5 decreased blood pressure when injected to fourth ventricle. 
The intent of this paper is to (a) provide an overview of PFS, (b) explore the case of a 16-year-old adolescent who presented with PFS following surgical resection of a fourth ventricle medulloblastoma, (c) reveal the complexity of her discharge, and (d) describe a discharge management framework used by the authors to guide the discharge process from a general pediatric unit in a tertiary care hospital..
Imaging revealed ventral pontine hypoplasia and mild cerebellar vermian hypoplasia, in addition to an unusual rounded to beaklike "bump" on the dorsal surface of the pons, extending into the fourth ventricle.
The rhombic lip (RL) is the neuroepithelium immediately adjacent to the roof plate of the fourth ventricle, and it gives rise to various brainstem and cerebellar cell types.
Magnetic resonance imaging and autopsy revealed a tumour extending from segment C3/C4 of the spinal cord to the lower half of the fourth ventricle with coexisting syringomyelia.
Six new entities were codified: angiocentric glioma (AG); papillary glioneuronal tumour (PGNT); rosette-forming glioneuronal tumour of the fourth ventricle (RGNT); papillary tumour of the pineal region (PTPR); spindle cell oncocytoma of the adenohypophysis (SCO); and pituicytoma.
We report a case of large choroid plexus papilloma of the fourth ventricle in a 23-year-old woman. We have discussed the effectiveness of this approach for removal of bulky tumors of the fourth ventricle and reviewed the literature about its benefits and potential hazards..
Neuropathological examination after formalin fixation revealed a cystic lesion in the fourth ventricle, ependymitis and acute hydrocephalus.
It is characterized by partial agenesis of the vermis, resulting in communication between the fourth ventricle and the cisterna magna.
Background Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a recently characterized rare tumor entity.
OBJECTIVE: Giant pediatric midline tumors of the posterior fossa involving the fourth ventricle and the tectal region are difficult to approach and present a high risk of postoperative neurological deficits. The tumor mass filling the fourth ventricle was removed via a transventricular telovelar route through the foramen of Magendie, preserving the vermis.
Brain MRI revealed an unhomogeneously enhanced, large-sized tumor (56 x 52 x 60 mm) mainly located in the pineal region expanding from the midbrain to superior portion of the cerebellum and the fourth ventricle.
METHODOLOGY/PRINCIPAL FINDINGS: We have analyzed the formation of the fourth ventricle ChP of zebrafish in the GFP-tagged enhancer trap transgenic line SqET33-E20 (Gateways) by a combination of in vivo imaging, histology and mutant analysis.
OBJECT: Microsurgical anatomy of the fourth ventricle has been comprehensively addressed by masterly reports providing classic descriptions of this complex region. Neuroendoscopy could offer a new, somewhat different perspective of the "inside" view of the fourth ventricle. The purpose of this study was to examine from the anatomical point of view the access to the fourth ventricle achieved by the endoscopic transaqueductal approach, to enumerate and describe the anatomically identifiable landmarks, and to compare them with those described during microsurgery. METHODS: The video recordings of 52 of 75 endoscopic explorations of the fourth ventricle performed at the authors' institution for different pathological conditions were reviewed and evaluated to identify and describe every anatomical landmark. According to the microsurgical anatomy, at least 23 superficial structures are clearly identifiable in the fourth ventricle, and they represent the comparative basis of parallel endoscopic anatomy of the structures found during the fourth ventricle navigation. CONCLUSIONS: On the whole, 20 anatomical structures could consistently be identified by exploring the fourth ventricle with a fiberscope. Neuroendoscopy offers a quite different outlook on the anatomy of the fourth ventricle, and compared with the microsurgical descriptions it seems to provide a superior and detailed visualization, particularly of the structures located in the inferior triangle..
There was no correlation between success rate and patient age or type of ventricular enlargement (normal or enlarged fourth ventricle).
Although sparing the fourth ventricle proper, both tumors had histological features consistent with the rare diagnosis of a rosette-forming glioneuronal tumor of the fourth ventricle, of which only 19 cases have been reported previously. CONCLUSION: These cases demonstrate that the rosette-forming glioneuronal tumor may be more accurately categorized as an infratentorial tumor rather than a tumor of the fourth ventricle.
RESULTS: Our techniques of septum pellucidum fenestration, third ventriculostomy, lamina terminalis fenestration, temporal ventriculostomy, foraminoplasty of the foramen of Monro, aqueductoplasty, aqueductal stenting, and retrograde aqueductoplasty for trapped fourth ventricle are presented.
Encephaloceles involving only the herniated fourth ventricle are exceedingly rare.
Nine (43%) occurred in other locations, including the parietal lobe (2/21), temporal lobe (2/21), cerebellum (2/21), basal ganglia (2/21), and fourth ventricle (1/21).
A computed tomography (CT) showed intratumoral bleeding, which extended to the subarachnoid space and the fourth ventricle.
In adult, choroid plexus-associated Pgp content was less than 0.5% of the level in microvessels, whereas Mrp1 content in microvessels was 4% of that in the fourth ventricle choroid plexus.
He underwent magnetic resonance imaging (MRI) the day before that revealed "a 5-mm enhancing mass with surrounding edema in the pons anterior to the fourth ventricle most likely compatible with pontine glioma." CT angiography of the brain was negative. During craniotomy, a small lesion of rubbery consistency was identified at the mid-portion of the floor of the fourth ventricle.
The cerebellar cleft extended into the fourth ventricle in three cases, and in two children cystic cortical lesions were seen.
Complete excision of cysts (fourth ventricle, 14; lateral ventricle, 4; third ventricle, 3; both lateral and third ventricles, 1) was performed in all patients.
The rosette-forming glioneuronal tumor of the fourth ventricle is one of a number of recently described glioneuronal tumors, which has been accorded official WHO nosologic status only in 2007. We describe the clinical and pathologic features of two patients with rare rosette-forming glioneuronal tumors of the fourth ventricle, one of which was associated with dysgenetic tricho-rhinopharyngeal type I syndrome..
A 4-year-old boy suffered frequent vomiting and was found to have a tumour in the fourth ventricle associated with obstructive hydrocephalus.
The tumor was attached to the choroid plexus out of the lateral recess, not in the fourth ventricle. The radiologic findings and operative approach differed from those for fourth ventricle meningiomas or cerebellopontine angle meningiomas.
U46619 0.3 mug administered into the fourth ventricle rapidly induced emesis.
Magnetic resonance imaging showed a solid mass in the fourth ventricle. CONCLUSION: These are tumors of young adulthood (range, 12-59 yr) usually in or close to the fourth ventricle.
Magnetic resonance imaging of the brain (MRI) revealed bilateral symmetrical lesion of abnormal hypersignal intensity on T2 and fluid-attenuation inversion recovery (FLAIR) sequences at bilateral dentate nuclei of cerebellum and periventricular area of the fourth ventricle.
The lateral ventricle was the most common site of involvement in the paediatric group compared with the fourth ventricle in adults.
fourth ventricle epidermoid cysts are rare lesions, arising from epithelial remnants at the time of neural tube closure. We present a case of a pathological proven less common fourth ventricle epidermoid cyst with special emphasis on the use of FLAIR and EPI-DW imaging sequences in the diagnosis..
Therefore, we examined Fos expression in the Arc, PVN, and NTS after injecting ghrelin into the fourth ventricle. Ghrelin did not increase Fos in TH-positive neurons in the NTS, suggesting that ghrelin delivered to the fourth ventricle does not act through catecholaminergic pathways.
Magnetic resonance imaging showed a mass arising from the left superior cerebellar peduncle and partially occupying the fourth ventricle.
The cranial MRI revealed a tumor in the third ventricle and a further tumor in the fourth ventricle, which could cause a transient obstruction of the CSF pathways.
Existing bibliography shows that haematomas greater than 4 cm or causing complete obliteration of the fourth ventricle or prepontine cistern need surgical evacuation irrespective of the level of consciousness, as they indicate a significant compression of the brainstem.
The computed tomography revealed a cyst-like dilation at the level of the fourth ventricle associated with vermal defect in the cerebellum.
Epilepsy from hamartoma of the floor of fourth ventricle (HFFV) is very rare, starting in neonate or infantile period, good response to surgery. A magnetic resonance imaging scan revealed mass lesion on the floor of fourth ventricle, with extended cerebellar peduncle and cerebellar hemisphere.
Dandy-Walker malformation (DWM) consists of a cystic dilatation of the fourth ventricle communicating with the posterior fossa, and a high insertion of the tentorium and hypoplasia/aplasia of the cerebellar vermis (partially caused by Zic1(+/-)Zic 4(+/-) on 3q2).
OBJECTIVE: To report a case of atypical positional vertigo revealing a fourth ventricle epidermoid cyst. MRI revealed a fourth ventricle epidermoid cyst.
OBJECT: The authors hypothesized that chemotherapy infusions directly into the fourth ventricle may potentially play a role in treating malignant posterior fossa tumors. In this study the safety and pharmacokinetics of etoposide administration into the fourth ventricle was tested using an indwelling catheter in piglets. METHODS: A closed-tip silicone lumbar drain catheter was inserted into the fourth ventricle via a posterior fossa craniectomy and 5 daily infusions of etoposide (0.5 mg in 5 animals) or normal saline (in 2 animals) were instilled. RESULTS: All piglets remained neurologically intact, and MR images demonstrated catheter placement within the fourth ventricle without signal changes in the brainstem or cerebellum. CONCLUSIONS: Etoposide can be infused directly into the fourth ventricle without clinical or imaging evidence of damage. Cytotoxic CSF etoposide levels can be maintained for 24 hours with a single daily infusion into the fourth ventricle using an indwelling catheter.
We report a patient with neurocysticercosis of the fourth ventricle who developed transient parkinsonism without evidence of midbrain dysfunction after placement of a VP shunt.
ependymal cells that lined the fourth ventricle and aqueduct, 2.
They usually occur in the lateral ventricles in children and the fourth ventricle in adults. We report a rare case of a 74-year-old patient with a fourth ventricle CPP associated with diffuse spinal deposits.
Direct administration of the N-methyl-d-aspartate ion channel blocker MK-801 into the fourth ventricle or the nucleus of the solitary tract where gut sensory fibres terminate abolished the upper-intestinal-lipid-induced inhibition of glucose production.
They are chiefly located in the pineal gland, the next most common being site being the suprasellar region and the fourth ventricle, although simultaneous presentation in these locations is relatively rare (5-10% of cases). Imaging with paramagnetic contrast agents revealed dissemination with ependymal uptake in relation to the frontal horns and in the fourth ventricle; a possible simultaneous origin was also suggested in this latter location.
By reviewing our cases and previous reports, we describe 4 neuronal and mixed neuronal-glial tumors (papillary glioneuronal tumor, extraventricular neurocytoma, rosette-forming glioneuronal tumor of the fourth ventricle, and glioneuronal tumor with neuropil-like islands), angiocentric glioma and papillary tumor of the pineal region, with an attempt to explain the pathological basis of the imaging features..
The case history of a woman with occlusive hydrocephalus caused by a fourth ventricle cyst is presented. The rapidly progressing neurological syndrome with worsening headache, gait disturbance and vomiting was finally identified and it turned out to be caused by a fourth ventricle CSF blockage of unknown aetiology. It revealed a huge fourth ventricle cyst, undetectable on MRI, occupying the whole ventricle.
To assess the contribution of hindbrain MC-Rs to the control of energy expenditure, the MC3/4R agonist melanotan II (MTII) was delivered to either the fourth ventricle or medullary raphe of neurologically intact rats and chronic decerebrate (CD) rats, and interscapular brown adipose tissue (IBAT) temperature (T(IBAT)), core temperature (T(C)), heart rate (HR), and spontaneous activity were recorded.
The patient was a 46-year-old woman who underwent surgery for a 3-cm tumor occupying the fourth ventricle.
CASE: A 3-year-old boy underwent emergency external ventricular drainage and excision of a fourth ventricle anaplastic ependymoma.
Imaging revealed features suggestive of two intracranial lesions; one non-contrast-enhancing high-signal area in the cerebellum with associated calcification, and a second contrast-enhancing low-signal area in association with the fourth ventricle, and at surgery there were two apparent components to the tumor.
The tumors were located in the parieto-occipital (n=2), temporal (n=1), parietal (n=1), frontal (n=1), and occipital lobes (n=1), as well as the lateral ventricles (n=2), insula (n=1), cerebellopontine angle (n=1), and fourth ventricle/cerebellopontine angle (n=1). The single case involving the fourth ventricle/left cerebellopontine angle consisted of subependymoma and fibrosarcoma components in roughly equal proportions at presentation.
Osteodural-neural decompression of the posterior fossa, performed with the patient in sitting position, revealed: compression of the brainstem, fourth ventricle and foramen of Magendie by herniated cerebellar tonsils, which were aspirated. MRI depicted the large created cisterna magna and also that the cerebellar tonsils did not compress the fourth ventricle, the foramen of Magendie and the brainstem, besides the enlargement of posterior fossa cisternae.
Cerebellar masses are a heterogenous group of conditions that can cause compression of the aqueduct or fourth ventricle, resulting in obstructive hydrocephalus, brainstem compression, and upward/downward herniation as a direct result of mass effect.
Intraventricular meningiomas are unusual, and meningiomas located in the fourth ventricle are even more so. We report a patient who harbored a prolactin-secreting pituitary adenoma and a fourth ventricle meningioma who was treated with surgical resection of the latter and medical treatment for the former.
Most of them are located in the posterior fossa in adults, the fourth ventricle being the most common location.
Magnetic resonance imaging showed vermian aplasia and dilated fourth ventricle, consistent with Joubert syndrome.
The present study shows that the peripheral administration of dexibuprofen (S(+)-isomer ibuprofen), which causes less gastric damage and has better anti-inflammatory effects than ibuprofen, reduces the microglial activation in the cortex and hippocampus, and reduces the phosphorylation of extracellular signal-regulated kinases in the hippocampus, which has been induced by chronic infusion of lipopolysaccharide (LPS) into the fourth ventricle of Wistar rats.
surgery near the area postrema at the floor of the fourth ventricle with the vomiting centre located nearby), recommendations based on trials in post-craniotomy patients may be flawed.
Magnetic resonance imaging showed, hydrocephalus with expanding fourth ventricle, and syringohydromyelia in the cervical spinal cord.
CASE DESCRIPTION: Her clinical symptoms mimicked malignant brainstem neoplasm disseminated to third and fourth ventricles and cervical spinal cord.
The major components of DWM are the following: partial or complete absence of the cerebellar vermis, a posterior fossa cyst continuous with the fourth ventricle, and hydrocephalus.
To determine the long-term effects and interaction of these systems on the brain and periphery, adult female rats were infused with lipopolysaccharide (LPS) into the fourth ventricle of the brain for 4 weeks, and ovariectomized rats were administered either constant or pulsed regimens of estrogen replacement (17beta-estradiol) until sacrifice at 8 weeks.
Computerized tomography (CT) was performed at admission within 24 hours of onset and retrospectively analysed to determine lesion size and location, status of third and fourth ventricle and frontal horn index (FHI).
Newly codified entities include atypical choroid plexus papilloma, angiocentric glioma, extraventricular neurocytoma, papillary glioneuronal tumour, rosette-forming glioneuronal tumour of the fourth ventricle, papillary tumour of the pineal region, anaplastic hemangiopericytoma, Ewing sarcoma - PNET, pituicytoma, and spindle cell oncocytoma of the adenohypophysis.
T(1)- and T(2)-weighted MR images revealed an isointense mass occupying the fourth ventricle with multiple cysts in the vermis.
Lateral and fourth ventricle ventriculoperitoneal shunts were placed. The fourth ventricle shunt required replacement at age 3 years.
Preoperative MR imaging demonstrated marked enlargement of the lateral ventricles as well as the third and fourth ventricle due to obstruction of the foramens of Luschka and Magendie. Spine MR imaging showed longitudinal dilatation of the central canal from the cerebrospinal junction toward the thoracic level with communication to the fourth ventricle, whereas Chiari malformation and tight cisterna magna were absent.
The conventional approach to the fourth ventricle is by splitting the vermis on the suboccipital surface of the cerebellum. A thorough understanding of the relationship of the branches of the PICA to the cerebellar tonsils are prerequisites for surgery in and around the fourth ventricle..
P2X7 mRNA was expressed in the ependymal cells around the olfactory ventricle, lateral ventricles (LV), third ventricle (3V), cerebral aqueduct (Aq), fourth ventricle (4V), and central canal.
Furthermore, to identify the location within the brain that mediates these effects, insulin was infused into either the lateral ventricle or the fourth ventricle.
Eighteen years later (in 1996), recurrence of tumor in the fourth ventricle was noted and was treated with gamma-knife radiotherapy.
These structures originate from the rhombic lip and adjacent dorsal precursor pools that border the fourth ventricle roofplate.
Mapping of the corticospinal tract, at the level of the cerebral peduncle as well as mapping of the VII, IX-X and XII cranial nerve motor nuclei on the floor of the fourth ventricle, is of great value to identify "safe entry-zones" into the brainstem. Mapping techniques allow recognizing anatomical landmarks such as the facial colliculus, the hypoglosseal and glossopharyngeal triangles on the floor of the fourth ventricle, even when normal anatomy is distorted by a tumor.
The area postrema is a medullary structure lying at the base of the fourth ventricle.
In this study we focused on blockade of the small channel or aqueduct connecting the third and fourth ventricles of the rat brain. A cannula was placed into the aqueduct between the third and fourth ventricle. A second cannula was placed into the third or fourth ventricle. A higher concentration of dispersion (3% wt.) was more effective in blocking the aqueduct and isolating the third from the fourth ventricle.
MIF-MO-injected embryos (morphants) displayed malformed eyes, abnormal swelling in the tectum and fourth ventricle region, and undeveloped jaw cartilage and pectoral fins.
We report four patients with fourth ventricle arachnoid cysts.
CASE DESCRIPTION: The patient underwent a brain CT scan that revealed a diffuse SAH and an IVH in the fourth ventricle with obstructive hydrocephalus.
These studies identified moderate to severe bilateral axonal degeneration within white matter regions of the cervical, thoracic, and lumbar spinal cord and in the white matter of the cerebral internal capsule and peduncle, in the roof of the fourth ventricle and inferior cerebellar peduncle, and in the external arcuate and pyramidal fibres of the medulla.
The cranial MRI revealed a tumor in the third ventricle and a further tumor in the fourth ventricle, which could cause a transient obstruction of the CSF pathways.
Local recurrence and metastasis (dissemination) via the CSF to the fourth ventricle developed about 52 months postoperatively. The tumor exhibited a histopathological appearance of transitional meningioma without cellular atypism in the original specimen, but in the metastatic nodules in the fourth ventricle and spinal subarachnoid space the histopathology was that of typical anaplastic meningioma.
The effects of fourth ventricle (4V) infusions of NPY (5 microg) and MCH (5 microg) on licking for water, 4 mM saccharin, and sucrose (0.1 and 1.0 M) solutions were compared to identify the contributions of each peptide to hindbrain-stimulated feeding.
A father and son presented ten years apart with a fourth ventricle ependymoma.
CT showed diffuse symmetrical swelling and oedema of the cerebellum resulting in compression of the fourth ventricle and hydrocephalus.
LPS were injected into the fourth ventricle of rat to make a neuroinflammatory murine model.
We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding.
The significance of surgery for choroid plexus tumors is well established, but surgical resection of those in the fourth ventricle has not been evaluated. This study reviewed five consecutive patients with choroid plexus tumors in the fourth ventricle treated in our institute between 1996 and 2005, focusing on the factors that hindered total extirpation. Infiltration into the fourth ventricle floor was apparent in all five patients during surgery, which hindered total resection of the tumors without neurological deterioration. Total resection of choroid plexus tumors in the fourth ventricle is difficult because of invasion into the fourth ventricle floor.
A review of our surgical experience in navigating the fourth ventricle prompted us to revisit the classical anatomic descriptions of the aqueduct and compare them using the novel perspective of neuroendoscopy. METHODS: We reviewed video recordings of 65 transaqueductal explorations of the fourth ventricle using flexible endoscopes, which were performed in our center to treat various pathological conditions. They include 21 patients with communicating normal pressure hydrocephalus, 6 patients with intraventricular hemorrhage, 5 patients with membranous obstruction of the foramen of Magendie, 5 patients with trapped fourth ventricle as evidenced after aqueductoplasty, 3 patients with colloid cysts, and 1 patient with craniopharyngioma with apparently normal aqueduct, which was navigated to aspirate small fragments of colloid and tiny clots.
The PICA had the most complex relationship to the cranial nerves of any artery and it is frequently exposed in approaches directed to the fourth ventricle.
We present clinical, imaging and intraoperative findings of an abscess occurring within the fourth ventricle which was associated with right chronic suppurative otitis media and right transverse sinus thrombosis.
It was determined that the obstructive hydrocephalus was caused by space-occupying lesions in nine patients (eight tumors and one with calcified arteriovenous malformation), aqueductal stenosis in 14 patients, and shunt infection and entrapped fourth ventricle in one patient.
The fourth ventricle showed cystic dilatation associated with an enlarged posterior fossa, characteristic for Dandy-Walker malformation.
qPCR was used to measure MCT2, GLUT3, GLUT4, GK, and SUR1 transcripts in the microdissected DVC, VMH, and LHA from groups of male rats treated by continuous infusion of aCSF or lactate into the caudal fourth ventricle (CV4), initiated prior to injection of Humulin R or saline.
Spinal cord dissemination over 10 years after surgical removal of the fourth ventricle ependymoma without local recurrence is extremely rare. A 49-year-old male underwent a macroscopically gross total removal of the fourth ventricle ependymoma and postoperative radiotherapy to the posterior fossa. Although the majority of the recurrences take place within a few years after surgery, we experienced a case with multiple spinal disseminations 12 years after the resection of the fourth ventricle ependymoma and administration of the radiation therapy to the posterior fossa.
We should rank among them the "classical" theories of Gardner and Williams based on the assumption that syringomyelic cavities result from directing the fluid from the fourth ventricle to the central canal of the spine in the case of disturbances of circulation of the cerebrospinal fluid in the region of the cranio-spinal junction.
Relaxin 3 mRNA appeared at embryonic day 18 in the near region of the fourth ventricle, and was shown to have increased its density and the number of expressing neurons by in situ hybridization and RT-PCR examination.
Imaging revealed a midline posterior fossa mass lesion compressing the fourth ventricle and causing hydrocephalus.
Fetal magnetic resonance provides a new tool in the imaging of the posterior fossa and is proving useful in cases that are difficult to assess sonographically by allowing further assessment of the fourth ventricle, cisterna magna, and vermian growth and development. We illustrate the tegmento-vermian angle, "closure" of the fourth ventricle, and communication of the fourth ventricle with the basal cisterns during development and in several disorders.
Computed tomography (CT) showed hemorrhage in the fourth ventricle.
GABAergic interneurons in the cerebellum differentiate from precursors expressing the Pax-2 transcription factor, generated in the subventricular zone of the embryonic fourth ventricle from where they migrate to the cerebellum.
Magnetic resonance imaging was performed, and an enlargement of the lateral, third, and fourth ventricles and syringomyelia were detected. The cat was diagnosed with an isolated fourth ventricle (IFV) with syringomyelia.
We found a mass in the cerebellar vermis abutting the floor of the fourth ventricle, which upon histological examination after surgery proved to be an ependymoma.
The circumventricular organs are small sized structures lining the cavity of the third ventricle (neurohypophysis, vascular organ of the lamina terminalis, subfornical organ, pineal gland and subcommissural organ) and of the fourth ventricle (area postrema).
Previously we showed that intermittent administration of nicotine (NIC) in the dark phase decreased food intake and body weight and this could be blocked when the NIC receptor antagonist mecamylamine was infused into the fourth ventricle. Catecholaminergic neurons adjacent to the fourth ventricle contain NIC receptors and directly innervate the perifornical hypothalamus (PFH) which has been shown to be involved in regulation of feeding.
We report on clinicopathological findings in two cases of rosette-forming glioneuronal tumor of the fourth ventricle (RGNT) occurring in females aged 16 years (Case 1) and 30 years (Case 2). Magnetic resonance imaging (MRI) indicated a cerebellar-based tumor of 1.8cm (Case 1) and 5cm (Case 2) diameter each, bulging into the fourth ventricle.
METHODS: Tumor of the fourth ventricle was clinically diagnosed in 86 patients basing on the preliminary assessment of symptom and CT or MRI findings.
BACKGROUND & AIM: Dandy-Walker malformation, a rare congenital brain malformation, is described as a triad of cystic dilatation of the fourth ventricle, complete or partial agenesis of the cerebellar vermis, and an enlarged posterior fossa with elevated tentorium.
Neuropathological findings were characterized macroscopically by hypoplasia of the posterior vermis with normal cerebellar hemispheres and brainstem; hypoplasia of the posterior vermian lobules 6 to 10, mildly cystic dilatation of the ventricular cavity, and a flat profile of the roof of the fourth ventricle also were demonstrated.
The fourth edition of the World Health Organization (WHO) classification of tumours of the central nervous system, published in 2007, lists several new entities, including angiocentric glioma, papillary glioneuronal tumour, rosette-forming glioneuronal tumour of the fourth ventricle, papillary tumour of the pineal region, pituicytoma and spindle cell oncocytoma of the adenohypophysis.
Computed tomography scans demonstrated mild to moderately enlarged third and the lateral ventricles, but the fourth ventricle was typically normal.
OBJECT: Patients with symptomatic isolated fourth ventricle and multicompartmentalized hydrocephalus benefit from operative treatment, but the optimal surgical approach and technique have yet to be established. The authors report on their experience with the treatment of symptomatic adult patients by endoscope-assisted placement of a fourth ventricle shunt catheter via a frontal transventricular approach. METHODS: The authors describe a retrospective series of four patients treated for isolated fourth ventricle. The transventricular approach allowed optimal catheter placement within the fourth ventricle. CONCLUSIONS: The endoscope-assisted dual-port technique provides a solution to the technical difficulties of fourth ventricle shunt placement. The multiple advantages of this technique include a single ventricular catheter shunt system that equalizes ventricular pressures, a frontal location for the ventricular catheter that facilitates valve placement and programming, and ventricular catheter placement within the fourth ventricle that does not allow the catheter to impinge on the fourth ventricle floor and makes the catheter less prone to obstruction..
Measurement of the corpus callosum and cerebellar vermis and visualization of the fourth ventricle and the main vermian fissures were compared.
These are the papillary glioneuronal tumor and the rosette-forming glioneuronal tumor of the fourth ventricle..
METHODS: Silicon oil was injected into the fourth ventricle of experimental canine for buildinghydrocephalus model.
A 13-year-old boy presented with syringomyelia associated with disproportionately large communicating fourth ventricle (DLCFV) manifesting as symptoms attributable to hydrocephalus and characteristic posterior fossa symptoms. Magnetic resonance imaging demonstrated remarkable dilation of the fourth ventricle and syringomyelia.
We report the first case of ectopic craniopharyngioma confined purely within the fourth ventricle, exophytic from pons.
For measurement of the hippocampus, we used T2-weighted coronal images parallel to the floor of the fourth ventricle.
In six patients, CNC extended into the third ventricle, and in two patients the tumor showed further contiguous intraventricular dissemination into the fourth ventricle. Although they are rare benign intraventricular tumors, in atypical cases, CNCs can show extensive intraventricular dissemination into the fourth ventricle..
Both vagal deafferentation and pretreatment with the CCK-A antagonist lorglumide on the floor of the fourth ventricle decreased the casein-induced increase in PES output.
Further investigation revealed a medulloblastoma within the fourth ventricle.
He had a history of repetitive radiation therapy - nine (whole-abdomen; 15Gy), 12 (whole brain; 30Gy, whole spine 42Gy) and 14 years ago (local; 32Gy) - for abdominal metastasis, temporal and fourth ventricle metastasis and spinal dissemination and metastatic pineal germinoma, respectively.
Computed tomography demonstrated acute hydrocephalus and hemorrhage within the brain stem and fourth ventricle.
The histopathologic diagnosis was epidermoid cyst within the fourth ventricle..
Eighteen hours after microinjection of 5,7-DHT into the DRN, fine-caliber degenerating serotonergic terminals were found within the region of the medial vestibular nucleus (MVN) that borders the fourth ventricle, and a mixture of fine- and heavier-caliber degenerating serotonergic terminals was located further laterally within the vestibular nuclear complex.
Univariate analysis showed that survival significantly correlated with metastasis, postsurgical performance status, brainstem involvement, involvement of the floor of the fourth ventricle (V4), and radiation dose to the spine and to the posterior cerebral fossa (PCF).
A 10-year-old boy with vermis hypoplasia, dilatation of the fourth ventricle, enlarged cisterna magna and aplasia of the corpus callosum, consistent with the Dandy-Walker complex (DWC), and slight facial dysmorphisms, severe motor and mental retardation is presented.
OBJECTS: fourth ventricle is conventionally accessed via resection of the part of the vermis for total excision of the tumors at the expense of significant morbidity. We attempt to emphasize the technique of telovelar approach and the problems encountered while employing this technique for excision of large fourth ventricle tumors. MATERIALS AND METHODS: Fifteen patients with fourth ventricle tumors were operated during January to September 2005 at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
In these cases, endoscopic opening of the foramen of Magendie by transaqueductal navigation of the fourth ventricle is a suitable and feasible therapeutic option..
Posterior fossa ependymoma usually arise in the fourth ventricle.
Plain CT scan of the cranium revealed a partly calcified tumor filling the fourth ventricle and its right recess. Complete resection of the tumor was carried out, and seedings to the floor of the fourth ventricle and cervico-medullary junction were found during the operation.
Multiloculated hydrocephalus was found in 7, lateral ventricle isolation in 14, fourth ventricle isolation in 3, intraventricular cyst accompanied hydrocephalus in 6, and adherent ventricular catheter of the shunt implanted previously in 8 cases.
Ambiguus motoneurons innervating the striated muscles of the larynx and esophagus take a long migration from their original birth plate in the floor of the fourth ventricle to their final settlement in the ventral margin of the medulla oblongata. In the P21 normal rat, HRP-positive laryngeal and esophageal motoneurons were found in the nucleus ambiguus, whereas in the P21 SRK, they were scattered from the base of the fourth ventricle to the ventro-lateral margin of the medulla, suggesting that radial migration of ambiguus motoneurons from their birthplace to their final settlement is guided by Reelin protein..
RESULTS: We found no definite communication between the fourth ventricle and syringomyelia by MRI in the 10 patients.
METHODS: The reported cases include (1) a 19-year-old adolescent boy and a 21-year-old man with Chiari I malformation and cervical syrinx compressing or tightening the cervico-medullary junction; (2) a 35-year-old man with ependymoma extending from the lower half of the fourth ventricle to C1/C2 junction and compressing this part of the medulla; and (3) a 16-year-old adolescent boy who was referred to the emergency department in severe distress because of IH, occurring as a result of a distal PICA aneurysm located on the floor of the lower triangle of the fourth ventricle.
Dilatation of the fourth ventricle, mainly at the level of the midbrain or upper pons (n=7), and hypoplastic cerebellar vermis (n=6) were commonly observed in both the early- and late-walking groups. Vermian hypoplasia and dilatation of the fourth ventricle at the upper brainstem level in COMA patients, with or without intellectual disabilities, suggested that the cardinal lesion for OMA may exist in these areas.
OBJECT: Endoscopic aqueductal stent therapy has evolved into an important technique in the treatment of a trapped fourth ventricle (TFV). Because it prevents aqueduct reocclusion by chronic inflammatory processes in postinflammatory hydrocephalus, it has been shown to be more efficient than aqueductoplasty alone and to be an important alternative to the placement of a fourth ventricle shunt. Intraventricular processes leading to membrane formation play an important role in occlusion of the cerebral aqueduct orifices and final isolation of the fourth ventricle in postinflammatory hydrocephalus..
BACKGROUND: During the embryonic development of the cerebellum, neurons are produced from progenitor cells located along a ventricular zone within dorsal rhombomere 1 that extends caudally to the roof plate of the fourth ventricle.
In contrast, Purkinje cells and inhibitory interneurons arise in the neuroepithelium of the fourth ventricle.
RESULTS: Our techniques of septum pellucidum fenestration, third ventriculostomy, lamina terminalis fenestration, temporal ventriculostomy, foraminoplasty of the foramen of Monro, aqueductoplasty, aqueductal stenting, and retrograde aqueductoplasty for trapped fourth ventricle are presented.
Approximately 2 months later, she developed acute obstructive hydrocephalus and was found to have small cystic lesions in the left ambient cistern, fourth ventricle and cerebral aqueduct, which had probably caused the previous ischemic symptoms due to emboli/ thrombi.
Although complete clearing from blood of the third and fourth ventricles was achieved in all patients after IVF, branching off the EVD failed because of increasing intracranial pressure (ICP). The combination of IVF to enhance clot resolution and to clear the third and fourth ventricle followed by LD may represent a new and promising approach in the therapy of hydrocephalus following severe ventricular hemorrhage..
We found that both hypothalamic and fourth ventricle injections of NPY, AGRP and NE significantly increased consumption of the intraorally-delivered milk.
pineal recess, pituitary recess, lateral ventricle, fourth ventricle) and lumbar cistern.
OBJECTIVE: To summarize important clinical, radiologic, and pathologic findings for 3 novel glioneuronal tumors (papillary glioneuronal tumor, rosetted glioneuronal tumor, and rosette-forming glioneuronal tumor of the fourth ventricle).
The trapped fourth ventricle is caused by occlusion of outlets of fourth ventricle, including cerebral aqueduct and foramina of Luschka and Magendie. The most common etiologies of obstruction to outflow of the fourth ventricle are infection and hemorrhage. Typical manifestation of trapped fourth ventricle is posterior fossa syndrome. However, trapped fourth ventricle occurred 9 months later. Unlike previous reports of trapped fourth ventricle, his presentation was motor neuron disease-like syndrome, including hand muscle weakness and atrophy, generalized brisk deep tendon reflexes, and absence of sensory deficits. Imaging study showed isolated dilatation of fourth ventricle and edema of cervical cord from obex to C7 level. The pathogenesis of hand muscle atrophy is secondary to cervical cord edema caused by trapped fourth ventricle and obstruction of cerebrospinal fluid (CSF) pathway.
We present the case of a 5-year-old boy who underwent surgery for a low-grade ependymoma in the fourth ventricle; 48 hours after surgical resection, the boy developed irritability, cranial nerve involvement and stereotyped movements in the context of active hydrocephalus.
A 51-year-old woman was operated on for a tumor of the fourth ventricle with histopathological diagnosis of CPP.
Large tumors that compress the brainstem and cause deviation of the fourth ventricle should first be removed surgically and any remnant should be treated by GKS..
BACKGROUND: Symptomatic cysts of epithelial origin occurring in the fourth ventricle are very rare. CASE 1: A 23-year-old male was diagnosed as having a cyst located in the fourth ventricle causing hydrocephalus; the patient underwent cyst removal via craniotomy. CASE 2: A 54-year-old woman was diagnosed as having a cystic mass in the fourth ventricle and dilatation of the ventricles. CONCLUSION: There is no proven mechanism to explain resolution of fourth ventricle cysts after a supratentorial VP shunting.
A CT scan revealed an enhancing vermian mass extending on to the fourth ventricle, which was excised and reported to be medulloblastoma.
Epitheliocyte height and the cross-sectional areas of the cytoplasm and cells were greatest in the choroid plexus of the lateral ventricle, while the cross-sectional area of the nucleus and the nucleus:cytoplasm ratio were greatest in the choroid plexus of the fourth ventricle; these features correlate with their functional characteristics.
OBJECTIVE: The purpose of this study was to show the normal sonographic embryologic anatomy of the cisterna magna septa, fourth ventricle, and cerebellar vallecula at various stages of development and our experience with their variable appearance in multiple planes and to discuss the probable relationship between the cisterna magna septa, Dandy-Walker continuum, mega cisterna magna, and persistent Blake's pouch. The cisterna magna septa become contiguous with the roof of the fourth ventricle inferior to the cerebellar vermis. The cerebrospinal fluid space enclosed between the cisterna magna septa is in direct contiguity with the fourth ventricle via the vallecula and is always completely anechoic because it develops intra- and not extra-axially.
Brain magnetic resonance imaging showed hypoplasia of the cerebellar vermis and inferior cerebellar peduncles, abnormal superior cerebellar peduncles with deepening of the interpeduncular fossa, and enlargement of the fourth ventricle.
In the present study we examined the effect of the CBr agonist, (R)-(+)-[ 2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)-pyrrolo[ 1,2,3-de]-1,4benzoxazin-6-yl]-1-naphthalenyl-methanone mesylate (WIN-55212-2), on microglial activation and spatial memory performance, using a well-characterized animal model of chronic brain inflammation produced by the infusion of lipopolysaccharide (LPS, 250 ng/h for 3 weeks) into the fourth ventricle of young rats.
After tumor removal, the floor of the lateral recess of the fourth ventricle and the convolution of the dorsal cochlear nucleos were reached, and the ABI was inserted.
RESULTS: All lesions were localised to the paramedian tegmentum just ventral to the fourth ventricle.
DWM is a malformation associating hypoplasia of the vermis, pseudocystic fourth ventricle, upward displacement of the tentorium, torcular and lateral sinuses and anterio-posterior enlargement of the posterior fossa.
The tumors affected a 16-year-old male and a 5-year-old female and involved the right frontoparietal lobe and fourth ventricle, respectively.
We draw attention to the diagnosis of cerebellar vermis lesions and tumours of the fourth ventricle by presenting two cases of patients with positional nystagmus of so called benign paroxysmal type.
When the patient did not need a fourth ventricular shunt after the EA with or without a stent, it was considered to be successful in patients with isolated fourth ventricle. CONCLUSION: EA with a stent can be performed in patients with isolated fourth ventricle and in patients with aqueduct stenosis in which ETV is not feasible.
OBJECTIVE: Compression of the fourth ventricle (CV-4) is a manual, noninvasive procedure that reportedly affects the cranial rhythmic impulse, a phenomenon recognized by practitioners of cranial manipulation, that is concomitant with low-frequency Traube-Hering (TH) oscillations in blood flow velocity.
CONCLUSION: The supratonsillar approach differs from the transvermian and telovelar approaches to the fourth ventricle, with a more superolateral trajectory that leads instead to the inferior cerebellar peduncle.
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