Symptomatic Isolated IV Ventricular Hydrocephalus in Adults: Clinical Diagnosis and Management of Five Cases

Isolated fourth(IV) ventricle in shunted patients has been reported with increasing frequency. Symptomatic isolated IV ventricular hydrocephalus in adults, however, has seldom been described. We report five such cases among total of 420 shunted cases in our institution from January 1992 to December 1995. The causes of initial hydrocephalus were postsurgical meningitis(SAH, teratoma and abscess of posterior fossa), tuberculous meningitis and neurocysticercosis of the IV ventricle. All cases were symptomatic with clinical findings related to posterior fossa lesions. Two patients developd symptoms in 2 months after V-P shunts and the others between 17 and 118 months after V-P shunts. These 5 patients required IV ventricular shunting. All patients improve postoperatively except one patient who developed 6th nerve palsy related to secondary irritation of the brainstem by the IV ventricular catheter. Inflammatory changes in the ependyma of both aqueduct of Sylvius, foramina Luschka and Magendi have been regarded as the most important factors in the development of the isolation of IV ventricle, especially in adults. It is generally recommended to shunt in cases of the adult symptomatic isolated IV ventricle. Alternative surgical techniques and prevention of such complications are discussed.

Coexistence of Neoplasia and Cortical Dysplasia Associated with Intractable Epilepsy: A Clinical Study of Seven Surgical Patients and Surgical Strategies

A tumor and cortical dysplasia may be the concomitant cause of the causes of intractable epilepsy, but a few studies have examined so far. From among 249 patients who underwent surgery for intractable epilepsy at Dongsan Epilepsy Center, those in whom neoplasia and cortical dysplasia coexisted were selected for this study, and were reviewed the clinical, electrophysiological, neuroimaging and pathological findings. In 17 of 25 lesionrelated epilepsy patients, tumors including dysembryoplastic neuroepithelial tumor(DNT)(n=6), ganglioglioma(n=5), gangliocytoma(n=1), low grade astrocytoma(n=2), oligodendroglioma(n=2), hypothalamic hamartoma(n=1) were verified. Of these 17 cases involving tumors, concomitant cortical dysplasia was observed in 7(DNT; 6, ganglioglioma; 1). All these patients underwent sophisticated presurgical evaluation and intraoperative acute recording(EcoG) for the identification of adjacent or remote epileptogenic areas as well as functional brain mapping by electrical stimulation or SSEP to verify the eloquent areas. In intractable epilepsy, the coexistence of cortical dysplasia and neoplasia is not common, though careful intraoperative evaluation of the tumor and surrounding tissue using electrocorticogram (EcoG) may lead to its pathological identification and excellent surgical results for these rare lesions.