Cirugía neuroendoscópica intraventricular en pacientes adultos con hidrocefalia obstructiva. Serie corta de casos

Introducción: la hidrocefalia es una patología neuroquirúrgica que presenta varias alternativas de tratamiento. A pesar de esto, el índice de disfunción y reintervención de los pacientes es considerablemente elevado. Objetivo: describir los resultados de la cirugía neuroendoscópica intraventricular en pacientes operados de hidrocefalia obstructiva. Materiales y métodos: se trata de un estudio observacional, descriptivo, transversal, de serie de casos, en el que se describen variables clínicas, de imagen y quirúrgicas de pacientes operados mediante neuroendoscopia intraventricular. Después de aplicar criterios de inclusión y exclusión, la muestra quedó conformada por cinco pacientes. Resultados: la escala de coma de Glasgow de los pacientes al momento de la cirugía, fue mayor de 12 puntos en todos los casos. El 60 % de los casos presentó un grado 4 en la escala de Frisen para evaluar la gravedad del papiledema. El promedio del índice de Evans medido por tomografía fue de 0,39; el del tercer ventrículo fue de 14,75 mm, mientras que el promedio de los cuernos temporales fue de 4,1 mm. En tres casos se presentaron variedades anatómicas dilatadas de los forámenes de Monro, mientras que en dos presentaban diámetros medianos. El tiempo quirúrgico promedio fue de 45 minutos. Entre las complicaciones posoperatorias estuvo la disfunción del estoma quirúrgico en un paciente con tercer ventriculostomía. Conclusiones: la cirugía neuroendoscópica intraventricular es un método efectivo para tratar pacientes con hidrocefalia obstructiva en pacientes seleccionados.

Introduction: hydrocephalus is a neurosurgical pathology that presents several treatment alternatives. Despite this, the rate of dysfunctions and re-interventions of the patients is considered high. Objective: to describe the results of intraventricular neuro-endoscopic surgery in patients operated on for obstructive hydrocephalus. Materials and methods: this is an observational, descriptive, cross-sectional study, of case series, where clinical, imaging and surgical variables of patients operated by intraventricular neurosurgery are described. After applying inclusion and exclusion criteria, the sample was made up of five patients. Results: the Glasgow coma scale of the patients at the moment of surgery was greater than 12 points in all cases. 60% of the cases presented a grade 4 on Frisen scale to assess the severity of papilledema. The average Evans index, measured by tomography was 0.39; that of the third ventricle was 14.75 mm, while the average of the temporal horns was 4.1 mm. In three cases there were dilated anatomical variants of the foramens of Monro f, while in two they presented medium diameters. The average surgical time was 45 minutes. Surgical stoma dysfunction in one patient with a third ventriculostomy was among the postoperative complications. Conclusions: intraventricular neuro-endoscopic surgery is an effective method for treating patients with obstructive hydrocephalus in selected patients.

Diagnosis and treatment of negative pressure hydrocephalus: analysis of 5 cases and literature review / 中国综合临床

Objective:To investigate the clinical manifestations, pathogenesis,diagnosis and treatment of negative pressure hydrocephalus (NPH).Methods:A retrospective analysis was performed on the 5 patients with NPH admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2019 to December 2021. All of the patients underwent lumbar puncture and ventricular puncture to test the pressure. Three patients underwent endoscopic third ventriculostomy (ETV), the outcome of the patients was observed.Results:The pressure of subarachnoid was not equal to intraventricular, and the pressure of intraventricular was negative. Cisternography showed cerebrospinal fluid circulation obstruction in all 5 cases. The symptoms of 1 patient were improved after external negative pressure drainage, 3 patients were improved after further ETV and 1 patient had pulmonary infection without further surgical treatment.Conclusion:With the obstruction of cerebrospinal fluid circulation, the pressure of lateral ventricle and subarachnoid is different, when the pressure of brain or subarachnoid drop, the ventricular expansion under the effect of pressure gradient, intraventricular pressure drop even for the negative pressure. CT cisternography provides strong evidence for the diagnosis of this disease. External ventricular drainage with negative pressure and ETV are effective treatment methods.

A rare case report: successful outcome of a patient at near term pregnancy with maternal chronic obstructive hydrocephalus due to tubercular meningitis

The incidence of tubercular meningitis leading to obstructive hydrocephalus is extremely rare accounting for 1% cases and is even rarer during pregnancy. A 20-year-old 2nd Gravida presented at 32 weeks gestation with complaints of intermittent headache, decreased vision since 3 months and irrelevant talks and agitated behavior since 1 day. On examination patient had stable vital signs but constant irritable behavior. Obstetric examination revealed a pregnancy corresponding to 32 weeks with a live fetus. Patient had a past history of Anti-tubercular therapy taken 2 years back for tubercular meningitis. Neurological examination revealed a GCS of 12/15 and Ophthalmologic examination revealed patient to be having only Perception of Light with optic atrophy on fundoscopy. NCCT head revealed moderate dilatation of bilateral ventricles and 3rd ventricle without any periventricular ooze suggestive of Chronic Obstructive Hydrocephalus. Supportive therapy was instituted with Dexamethasone and Mannitol infusion after Neurosurgical consultation along with antenatal care. Decision for termination of pregnancy was taken at 35 weeks by an elective caesarean section with simultaneous ventriculo-peritoneal shunt insertion by neurosurgical team under general anesthesia. A live male baby of 2.25 kg was delivered. Patient with baby was discharged on 10th post-operative day. Obstructive hydrocephalous developing post tubercular meningitis in pregnancy is a rare event. Caesarean section was done along with shunt surgery in our case. Very few cases have been reported in the medical literature so far.

Diverse Presentation of Intraventricular Colloid Cysts – A Tale of Eight Cases

Introduction: Colloid cysts are one of the benign intracranial tumors most commonly occurring in the rostral part of the thirdventricle. These may present with varied spectrum of clinical features that poses challenges in clinical diagnosis. The presentationmay range from being asymptomatic to simple headaches, seizures, and even sudden death. Most of the symptoms can beattributed to the development of obstructive hydrocephalus. Chemical or aseptic meningitis is unusual complication posingcomplicating differential diagnosis. We describe eight such cases with wide variety of symptoms.Materials and Methods: We present a case series of eight cases of the third ventricle colloid cysts presented at our institute.Age of the patients ranged from 15 to 55 and five of them were females. All the clinical features were recorded from eachone of them. Computed tomography and magnetic resonance imaging were used to diagnose the condition. Four of themunderwent excision of the cyst in single stage either by open or endoscopic approach. Two patients underwent preliminaryventriculoperitoneal shunt done in the view of poor neurological status and craniotomy and excision was done in later stage. Inone patient bedside external ventricular drain was inserted for emergency decompression of ventricles. One patient is underserial radiological follow-up.Results: Eight cases that we observed had wide variety of symptoms. Six patients had chronic headache with progressiveseverity, and four of them had nausea with vomiting, three patients had seizures. The cysts in two patients were discoveredaccidentally, during the evaluation of seizures in one patient and others in evaluation of traumatic head injury. One elderly patienthad presented with psychiatric symptoms, drop attacks along with the features of normal pressure hydrocephalus. One teenagepatient presented with sudden deterioration and went into cardiac arrest even after emergency decompression of ventriclesdone. Seven of them underwent surgery and one of them succumbed. The surgery improved health in all other seven patients.Conclusion: Colloid cysts may present with a wide range and beyond expected neurological manifestations. The severity orrapid clinical deterioration does not exactly correlate with depending on the site, size of the cyst. Leaking cysts with chemicalmeningitis may further complicate the diagnosis. Hence, early diagnosis and surgery with complete removal of cysts offer betterclinical outcomes in those patients.

Effect of third ventriculostomy under neuroendoscopy on neurological function in children with obstructive hydrocephalus / 中华实用儿科临床杂志

Objective To explore the effect of third ventriculostomy under neuroendoscopy in the treatment of children with obstructive hydrocephalus.Methods Thirty-eight cases of obstructive hydrocephalus treated at Zhumadian Central Hospital from January 2015 to December 2017 were selected,and among them there were 20 males and 18 females,aged ＜ 12 months in 4 cases,1-3 years in 17 cases and 3-6 years in 17 cases.The children were treated by third ventriculostomy under neuroendoscopy,the therapeutic effect was observed,and the brain cognitive function was evaluated by Gesell child intelligence development diagnostic scale.Results After treatment,81.58％ (31/38 cases) of children were improved,the conditions of 10.53％ (4/38 cases) of patients did not change,and 7.89％ (3/38 cases) of patients got aggravated.The development quotient(DQ) scores of 1 month,3 months and 6 months after operation were (57.20 ± 5.81) scores,(75.12 ± 6.02) scores and (80.43 ± 7.00) scores,respectively,which were significantly higher than those of the preoperative scores [(50.12 ± 6.11) scores] (t =6.933,8.192,10.033,all P ＜0.05),and the DQ scores at 6 months after operation were (80.43 ± 7.00),which were significantly higher than those of 1 month and 3 months after operation (t =5.192,7.022,all P ＜0.05).The width of ventricle frontal horn at 1,3 and 6 months after operation was (37.82 ± 6.01) mm,(38.00 ± 5.89) mm and (37.03 ± 5.25) mm,respectively,which was significantly lower than that of preoperative width [(44.01 ± 5.61) mm] (F =24.292,P ＜ 0.05).The width of third ventricle at 1,3 and 6 months after operation was (16.89 ± 3.82) mm,(16.72 ± 4.10) mm and (16.11 ± 4.11) mm,respectively,which was significantly lower than that of preoperative width [(21.02 ± 4.37)mm] (F =19.143,P ＜ 0.05).The levels of adrenomedullin and neuron specific enolase decreased significantly at 1 month,3 months and 6 months after operation (F =45.281,11.022,all P ＜ 0.05).No serious complications occurred.Conclusions Third ventriculostomy under neuroendoscopy is effective in treating obstructive hydrocephalus in children and may improve the cognitive function in children.

Observation of cerebrospinal fluid circulation of fistula after ETV in obstructive hydrocephalus by PC-cine MRI / 实用放射学杂志

Objective To observe the feasibility of PC-cine MRI for estimating the cerebrospinal fluid circulation of fistula after endoscopic third ventriculostomy (ETV)in obstructive hydrocephalus.Methods 25 cases with obstructive hydrocephalus were scanned with routine MR protocol and PC-cine sequence before and after ETV.Qualitative and quantitative evaluation of the cerebro-spinal fluid flow through the fistula were performed and the results were compared with 25 cases of healthy volunteers.Results One week after operation,the cerebrospinal fluid flow through the fistula showed obviously positive in 23 patients,while negative in the other 2 patients,and the waveform was similar to that in the normal midbrain aqueduct.The outflow and inflow peak velocity of the cerebrospinal fluid through the fistula were lower than that in normal midbrain aqueduct(P<0.05),while the quantity of outflow,inflow and netflow were much higher(P<0.05).6 patients showed ventricular narrowing one week after operation and 17 cases maintained the same finding.During follow-up of half year,the ventricular size still showed no obvious narrowing in 14 patients.Ventricular expanding was observed in 2 post-operative patients.Conclusion PC-cine MRI can provide intuitive and reliable evidences in evaluation of ETV for obstructive hydrocephalus.

Schwanoma gigante do VIII nervo craniano de evolução subaguda: relato de caso / Subacute evolution of giant schwannoma of VIII cranial nerve: case report

O schwanoma vestibular é uma neoplasia que se origina das células de Schwann da porção vestibular do VIII nervo craniano e que corres- ponde a cerca de 10% dos tumores intracranianos e a 80% a 90% daqueles localizados no ângulo pontocerebelar. Apesar do crescimento lento e evolução em geral benigna, estes tumores podem evoluir de maneira desfavorável devido à localização em compartimento anatômico relativamente reduzido no crânio (fossa posterior), o que pode levar a compressão de estruturas nobres (como o tronco encefálico) e a desenvolvimento de hidrocefalia obstrutiva, especialmente nos raros casos de schawanomas gigantes (> 40 mm). Apresentamos relato de caso de paciente com quadro de tinnitus e hipoacusia à esquerda que evoluiu de forma subaguda com alterações do humor, da cognição e da marcha cujo diagnóstico final foi de schwanoma gigante do VIII nervo craniano.

Vestibular schwannoma is a Schwann cells neoplasia of the vestibular branch of the VIII cranial nerve and it accounts for 10% of intracranial tumours and to 80%-90% of those located at the cerebellopontine angle. Despite slow growth and usual benign evolution, unfavourable outcomes may occur, especially in the rare cases of giant schwanno- mas (> 40mm). Owing the fact that this tumours are located in a relatively narrow space (posterior fossa), giant schwannomas may compress noble areas (as the brainstem), which can also cause obstructive hydrocephalus. We discuss a case report of a 48 years old woman complaining of left-sided hearing loss and tinnitus that developed a subacute cognitive impairment, mood disorder and gait disturbance, diagnosed with giant schwannoma of the VIII nerve.

The Efficacy Analysis of Endoscopic Third Ventriculostomy in Infantile Hydrocephalus

OBJECTIVE: To investigate the efficacy of endoscopic third ventriculostomy (ETV) for infantile hydrocephalus. METHODS: Retrospectively reviewed the 17 infantile hydrocephalus cases who were treated with ETV between July 2009 and June 2013. The study includes 17 patients (4 Han and 13 Hui) between the ages of 51 and 337 days. Five cases with encephalitis history and 2 cases with cerebral hemorrhage, with the remaining 10 cases congenital hydrocephalus. ETVs were performed for all patients with 1 case failing because the severe ventricle inflammatory adhesion, excessive exudation, and vague basilar artery. RESULTS: Among the 16 successful cases 7 cases improved remarkably : heads and ventricles reduced and cerebral cortexes thickening morphologically. The ventricles of the remaining cases were unchanged. CONCLUSION: The ethnic minority account for the majority of the patients in this study. ETV is effective for infantile obstructive hydrocephalus.

Related factors analysis of obstructive hydrocephalus secondary to intracranial hemorrhage in premature infants / 临床儿科杂志

ObjectiveTo explore the risk factors of obstructive hydrocephalus secondary to intracranial hemorrhage in premature infants.MethodsA total of 304 premature infants were selected who were diagnosed as sever intracranial hemor-rhage (grade III and IV) by cranial bedside ultrasound admitted to our hospital from Jun. 2013 to Sep. 2014. According to wheth-er the obstructive hydrocephalus was followed, all infants were divided into hydrocephalus group (n=59) and non-hydrocephalus group (n=185). The risk factors of obstructive hydrocephalus secondary to intracranial hemorrhage were analyzed and the lateral ventricle size was measured dynamically.ResultsThe univariate analysis showed the factors related with obstructive hydro-cephalus were as follows: gestational age≤32 weeks, birth weight< 1500g, severe asphyxia, cesarean section, RDS, neonatal infection, heart failure, PDA, acidosis, thrombocytopenia, coagulation abnormalities, and intracranial hemorrhage (gradeⅢ orⅣ) (allP<0.05). Multivariate logistic regression analysis showed that acidosis, thrombocytopenia, coagulation abnormalities, gesta-tional age≤ 32 weeks, severe asphyxia, intracranial hemorrhage (gradeⅢ orⅣ) were independent risk factors for obstructive hydrocephalus (OR: 1.76~20.46, allP<0.05). At each time point after birth, the ratio of posterior horn of lateral ventricle was signiifcantly higher in hydrocephalus group than that in non-hydrocephalus group (P<0.05). There were signiifcant differences in the changes of the posterior horn ratio of left or right lateral ventricle with time in hydrocephalus group (P=0.000), increasing at 14 days and reaching the peak at 28 days after birth.ConclusionsThe risk factors for obstructive hydrocephalus secondary to intracranial hemorrhage in neonates are important. Regular and dynamical monitoring of ventricle size by cranial ultrasound is needed in infants with sever intracranial hemorrhage.

Effect of endoscopic third ventriculostomy in treating severe obstructive hydrocephalus in premature infant / 中华实用儿科临床杂志

Objective To discuss the treatment and the clinical effect of endoscopic third ventriculostomy on severe obstructive hydrocephalus in premature infant.Methods Eleven patients were operated,ultrasound,CT and MRI showed severe obstructive hydrocephalus and cerebral spinal fluid absorption was normal.The technique was that endoscope was inserted through the foramen of Monro into the third ventricle,then perforating the floor of the third ventriculostomy.Comparison before and after surgery of ventricular system ultrasonic measurement about the change of lateral ventricle and the MRI and CT imaging changes were performed.The complications,operation effect and security were observed.The bailey baby scale and Peabody movement function scale was used to assess the patient's neurologic system status.Results The follow-up time was 6 months and 6 years after operation,an excellent operative result was got in 9 cases.The ventricular width of 1 patient was mild ventriculomegaly,but stayed stabilily.No change of ventricular width was found in 1 case.Additional shunt were needed in 1 case.No severe complications were found.The left and right lateral ventricle measured by ultrasonic before operation were (9.60 ± 3.52) mm and (8.63 ± 3.10) mm before operation,and (5.50 ± 2.20) mm and (4.90 ± 2.70) mm after operation.The 11 cases of lateral ventricle side edema were disappeared,the follow-up time in 9 cases were more than 12 months,obstructive hydrocephalus clinical symptoms were relieved.Conclusions Ventricular mirror operation significantly improve severe hydrocephalic short and longterm poor prognosis,it is a safe,effective and less complications of minimally invasive surgery.

Intraventricular Glioblastoma Multiforme with Previous History of Intracerebral Hemorrhage : A Case Report

GBM is the most common primary brain tumor, but intraventricular GBM is rare and only few cases have been reported in the literature. The authors report a case of 64-year-old man who had a remote history of previous periventricular intracerebral hemorrhage. Brain computed tomography (CT) and magnetic resonance (MR) imaging showed an intraventricular lesion with inhomogeneous enhancement, infiltrative borders and necrotic cyst, and obstructive hydrocephalus. The patient underwent surgical removal through transcortical route via the bottom of previous hemorrhage site and the final pathologic diagnosis was GBM. We present a rare case of an intraventricular GBM with detailed clinical course, radiological findings, and pathological findings, and the possible origin of this lesion is discussed.

Outcome of Endoscopic Third Ventriculostomy

OBJECTIVE: The authors review 17 cases of obstructive hydrocephalus treated with endoscopic third ventriculostomy to elucidate the adequate age, indication, surgical technique and radiologic criteria. METHODS: From March 1998 to August 2002, 17 endoscopic third ventriculostomies were performed(11 male and 6 female patients). The operation records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: The age of the patients ranged from 2 months to 70 years(mean age 21 years). Hydrocephalus was caused by aqueductal stenosis in 8 patients, tumor in 8(pineal mass: 5, cystic mass in third ventricle: 2 cerebellar mass: 1), cavernous angioma in 1. The overall success rate was 64.7%(11/17). In the present study, the preoperative increased intracranial pressure symptom was a reliable indicator of surgical outcome. The lateral ventricular size and the III ventricle width reduction, the presence of a signal void on the third ventricle floor appeared to correlate with clinical success. But the cystic mass in the third ventricle was less likely to benefit. Complications were bleeding in 3, infections in 2 and transient III and VI nerve palsy in one case, but there was no permanent morbidity or mortality. CONCLUSION: Endoscopic third ventriculostomy is a safe, simple, effective alternative treatment option of obstructive hydrocephalus in appropriate patient selection.

Clinical application anatomy and endoscopic views of interventricular foramen / 中华显微外科杂志

Objective To study the clinical application anatomy of interventricular foramen and offer a base for operation.Methods Interventricular foramens were observed in 15 adult cadaveric brainThirty- two patients of obstructive hydrocephalus were operated to observe the structure of interventricular foramen un- der neuroendoscope.Results Interventricular foramen was a poriform structure which consists of fornixan- terior pole of thalamencephalon and choroid plexus and was a oval shape in most of themThe plane of the fo- ramen was a included angle with the median sagittal planeThe septal veinthalamostriate veinthalamen- cephal and even the floor of third ventricle could be observed clearly in endoscope.At the same timewe found the foramen had a significant change in obstructive hydrocephalus.Conclusion The interventricular foramen has a simple relatively structure but a variation on size and shape especially in obstructive hydroceph- alusA clearly comprehension of it's structure and adjacent is a base to microsurgery and endoscopic surgery on the foramen.

Endoscopic surgery for obstructive hydrocephalus

Endoscopic surgery is popular in the neurosurgical field. The purpose of this study was to determine the role of endoscopy in obstructive hydrocephalus. From 1989 to 1999, we performed 81 endoscopic third ventriculostomies and 10 septostomies. Seventy-one of 81 operations were performed with endoscopic third ventriculostomy alone and 10 patients had endoscopic third ventriculostomy and ventriculoperitoneal shunt simultaneously. Age distribution varied from 2 months to 62 years of age. Our selection criteria included aqueductal stenosis (39 patients) and obstructive hydrocephalus due to tumor or cyst (42 patients). The most common candidate for endoscopic septostomy was atresia of the foramen of Monro (4 patients). Endoscopic septostomy was also performed to simplify shunting in patient; with multiseptated ventricle due to shunt infection, germinoma, thalamic tumor, craniopharyngioma, cyst and brain abscess. Sixty-five of 71 patients who were treated with endoscopic third ventriculostomy alone showed successful results (91.5%). However, 6 patients had unsatisfactory results and they needed a ventriculoperitoneal shunt. With no mortality, transient surgical complications were observed in 7 patients: 2 transient diabetes insipidus from electrical injury to the pituitary stalk, 1 epidural hematoma from sudden drainage of CSF, 1 delayed intraventricular hemorrhage. 2 obstruction of fenestration site and 1 transient memory disturbance from injury to the fornix. Endoscopic septostomy was useful in simplifying shunting in all cases with complicated hydrocephalus. Endoscopic surgery is straightforward and effective in appropriately selected cases with obstructive by drocephalus.

Clinical Evaluation of Outcome of Hypertensive Cerebellar Hemorrhage

The authors analyzed 28 cases with hypertensive cerebellar hemorrhage, diagnosed by computerized tomography(CT), between 1987 and 1990, in Chonbuk National University Hospital. The authors assessed the relationship of outcome to the CT appearance of the quadrigeminal cistern, which in some cases was obliterated by rostral displacement of the vermis resulting from the cerebellar mass. Obliteration of the quadrigeminal cisterns was classified on the CT scans into three grades:Normal(Grade I), Compressed(Grade II), or Absent(Grade III). There were 7 cases with Grade I, 9 with Grade II, and 12 with Grade II cisterns. Of the 28 cases, 6(85%) of those with Grade I, 7(78%) of those with Grade II, and none of those with Grade III cisterns respectively returned to their previous activities at 6 months or more after onset. A Grade I cisterns predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved early. However, a Grade II cistern was not predictive of a good outcome unless the hematoma was evacuated within 48 hours after onset of the hemorrhage. A Grade III cisterns predicted an unfavorable outcome. Taken together, these results strongly suggest that the CT grade of quadrigeminal cistern obliteration may be an indicator of outcome and may be useful in selecting treatment for patients with cerebellar hemorrhage.

Clinical Evaluation of Outcome of Hypertensive Cerebellar Hemorrhage

The authors analyzed 28 cases with hypertensive cerebellar hemorrhage, diagnosed by computerized tomography(CT), between 1987 and 1990, in Chonbuk National University Hospital. The authors assessed the relationship of outcome to the CT appearance of the quadrigeminal cistern, which in some cases was obliterated by rostral displacement of the vermis resulting from the cerebellar mass. Obliteration of the quadrigeminal cisterns was classified on the CT scans into three grades:Normal(Grade I), Compressed(Grade II), or Absent(Grade III). There were 7 cases with Grade I, 9 with Grade II, and 12 with Grade II cisterns. Of the 28 cases, 6(85%) of those with Grade I, 7(78%) of those with Grade II, and none of those with Grade III cisterns respectively returned to their previous activities at 6 months or more after onset. A Grade I cisterns predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved early. However, a Grade II cistern was not predictive of a good outcome unless the hematoma was evacuated within 48 hours after onset of the hemorrhage. A Grade III cisterns predicted an unfavorable outcome. Taken together, these results strongly suggest that the CT grade of quadrigeminal cistern obliteration may be an indicator of outcome and may be useful in selecting treatment for patients with cerebellar hemorrhage.

A Case of Oligodendroglioma in the Septum Pellucidum

The authors report a case of oligodendroglioma in the septum pellucidum. A 22-year-old male presented with symptoms of headache and decreased visual acuity. Simple skull series showed calcified density near the midline. Brain C-T scan revealed huge calcified mass involving right lateral ventricle, 3rd ventricle and obstructive hydrocephalus. The authors diagnosed oligodendroglioma in operative findings and pathologic examination.

Cerebellar infarction with obstructive hydrocephalus report of a case with non-surgical treatment.

This is a report of a 60 year old woman who had an abrupt onset of right sided weakness, headache, vomiting and alteration of consciousness. She had a lumbar puncture performed which resulted in comatose and an enlarged right cerebellar infarction with marked hydrocephalus. Surgical intervention was refused and frusemide was given intravenously to reduce the formation of cerebrospinal fluid. She gained her consciousness on the tenth day after overcoming superimposed infection of both pneumonia and urinary tract infection. She was discharged on her nineteenth hospital day with minimal right hemiparesis (grade 4/5 MRC grading). Clinical features and management of cerebellar infarction was reviewed in detail.