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• W2770623497 abstract "To the Editor: Spontaneous third ventriculostomy (sTV) is a rare finding in which chronic obstructive hydrocephalus results in ventricular auto-rupture into the subarachnoid space, often accompanied by resolution of symptoms of chronic hydrocephalus. To the best of our knowledge, 19 clinical cases of sTV have been reported in the English literature, and 3 cases reported at postmortem examination (references available upon request). We would like to share an illustrative case of a young male with sTV confirmed clinically and by cerebrospinal fluid (CSF) flow study. Our Research Ethics Board did not deem patient consent to be necessary. This 27-yr-old male suffered a severe traumatic brain injury when he was struck by a car while bicycling. He recovered after hospitalization with no need for intervention. Over the next 8 mo, he developed progressive headaches, intermittent blurry vision, bilateral tinnitus, and occasional episodes of vertigo. A computed tomography (CT) scan of the brain performed 6 mo after his injury revealed hydrocephalus compared to his initial studies, prompting neurosurgical consultation. A magnetic resonance imaging (MRI) was ordered. At his next appointment, 10 mo after his injury, the patient reported that he had been headache-free for 2 mo. His MRI showed evidence of aqueductal stenosis and turbulent flow into the prepontine cistern, with decreased ventriculomegaly compared to his prior CT. Phase-contrast CINE MR imaging confirmed CSF flow through the defect in the floor of the third ventricle. Ventriculostomy involves the creation of a communication between the ventricles and the subarachnoid space through compromise of the ependymal lining of the ventricle. sTV involves the spontaneous formation of a defect in the flow of the third ventricle, typically as a result of long-standing hydrocephalus.1-3 As sTV is typically associated with symptom resolution, it is possible that sTV may be under-reported, as patients may not present for further evaluation because of clinical improvement. sTV has been reported at all ages, from 2 mo to 68 yr, with an average age of 35.1 yr. In most of these cases, sTV was found to occur in the setting of chronic hydrocephalus secondary to benign or congenital stenosis of the foramen of Monro or a neoplastic lesion. Many authors have postulated that sTV does not occur in patients with acute hydrocephalus because of the protective elasticity of the walls of the ventricles, which prevents rupture after a rapid rise in intraventricular pressure.4 The duration between the onset of hydrocephalus until the resolution of symptoms or the radiological confirmation of sTV is not adequately reported in all cases. However, the longest periods from the initial diagnosis of hydrocephalus to the diagnosis of sTV were 8, 10, and 13 yr.5-7 These findings may advocate the wait-and-see approach in benign case of chronic hydrocephalus. Imaging features of sTV include a prepontine flow artifact on sagittal T2-weighted and fluid-attenuated inversion-recovery images, and evidence of CSF flow through the stoma in CINE MR images. Although sTV is a rare entity, these imaging features should be carefully considered in patients with long-standing hydrocephalus, especially before attempting an endoscopic third ventriculostomy.8 Since most cases of sTV were associated with spontaneous resolution of symptoms, further surgical intervention has rarely been needed. Spontaneous resolution or improvement of initial symptoms is reported in nine patients including the present case. Two patients required surgical intervention in the form of CSF diversion. Only 1 case was endoscopically explored.9 Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
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• W2770623497 date "2017-11-22" @default.
• W2770623497 modified "2023-10-16" @default.
• W2770623497 title "Letter: Spontaneous Third Ventriculostomy in a Patient Following Traumatic Brain Injury" @default.
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• W2770623497 doi "https://doi.org/10.1093/ons/opx268" @default.
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