Hydrocephalus in patients with neurofibromatosis type 1: MR imaging findings and the outcome of endoscopic third ventriculostomy.

Although hydrocephalus associated with NF-1 is not rare, up to now the MR imaging findings in these patients and the role of ETV in the treatment of hydrocephalus associated with NF-1 have not been investigated thoroughly. We present the MR imaging findings of hydrocephalus associated with NF-1 in 7 of 54 patients with NF-1. Although the types of obstruction were various, including aqueductal web, superior velum medullary synechia, periaqueductal/tectal hamartomas, cerebellar and pontine tegmentum hamartomas, brain stem glioma, or a combination, the presence of hamartomas was a consistent finding in patients with NF-1 with hydrocephalus. In 5 cases, 8 ETV procedures were performed and followed for up to 53 months. All children treated with ETV were shunt-free at their most recent examinations. ETV may be the primary procedure for the treatment of hydrocephalus associated with NF-1, regardless of the cause and the level of the obstruction.

Posterior epidural disc herniation at L3-L4 mimicking a spinal tumor: a case report.

Posterior epidural disc migration is a rare event. Many differential diagnoses are possible in the posterior epidural space other than disc disease. This is a case report of L3-L4 posterior epidural disc herniation that was misdiagnosed as a tumor depending on the preoperative magnetic resonance imaging study with a peripheral ring enhancement around the mass lesion after IV gadolinium. Decompressive L4 laminectomy was performed and a free disc fragment was observed beneath the lamina. There wasneither dural tearnor attachment to it. The patient was free of pain postoperatively. After 3 months, the patient applied to the outpatient clinic for a regular control T he patient was neurologically intact and free of pain. Diagnosis of posterior migrated disc fragment with subtle clinical findings, even though the free fragment has to pass through many anatomical barriers including the nevre roots, is a clinical challenge. Many differential diagnoses should be kept in mind. MRI findings (especially with contrast material use) are useful which should be imprinted with clinical knowledge.