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• W2051269627 abstract "The first case of congenital occlusion of the aqueduct of Sylvius was reported by Hilton in 1847. Pancoast, Pendergrass, and Schaeffer have stated in their classic work, “The Head and Neck in Roentgen Diagnosis,” that of all of the lesions revealed by ventriculography those obstructing the aqueduct are the most difficult to diagnose. Twining emphasized the danger of being misled by inadequate visualization of the aqueduct and fourth ventricle and discussed the hydrodynamics involved in filling these structures with air. Complete replacement of cerebrospinal fluid with air is seldom possible by ventricular puncture in the presence of a blocked ventricular system. The difficulties encountered, therefore, are largely technical and involve positional manipulation of the available air to establish the point of occlusion of the system. However, there are also the possibilities of an incomplete block of the aqueduct and unsatisfactory visualization of an air-filled aqueduct due to superimposed structures that obscure it. The roentgenologist is so often called upon for aid in establishing the preoperative diagnosis by air studies of the ventricular system that it seems justifiable to discuss the difficulties encountered in this procedure. The roentgen diagnosis is dependent upon failure to visualize the aqueduct, together with the positive findings of obstructive hydrocephalus, namely: (1) symmetrical dilatation of the lateral ventricles; (2) dilatation of the foramina of Monro; (3) dilatation of the third ventricle; (4) dilatation of the aqueduct rostral to the point of obstruction. These criteria may be established by conventional positioning in most cases in which an adequate replacement of fluid by air is effected by the neurosurgeon. In some cases, however, the superimposed bony structures of the cranium or air in dilated lateral ventricles may obscure the region of the aqueduct, necessitating the use of body-section roentgenography. Mid-line lateral laminagrams will give clear visualization of the aqueduct and third and fourth ventricles in such cases. In all instances of failure to visualize the aqueduct or fourth ventricle by conventional roentgenography, we resort to laminagraphic sections in both lateral and frontal projections. The use of heavy opaque media to demonstrate the point of obstruction, as recommended by Olivecrona, Lysholm, Freeman, and others, is not without risk and has not been regarded favorably by our neurosurgical colleagues. Ventricular injection of lipiodol has been used only once in our clinic for corroboration of the point of occlusion of the aqueduct of Sylvius. Definite localization of the site of obstruction in obstructive hydrocephalus is of paramount importance. A surgical decision to explore the lesion above or below the tentorium may rest largely upon the ventriculographic findings." @default.
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• W2051269627 date "1946-02-01" @default.
• W2051269627 modified "2023-10-17" @default.
• W2051269627 title "Lesions of the Aqueduct of Sylvius" @default.
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• W2051269627 doi "https://doi.org/10.1148/46.2.132" @default.
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