Presentation
Chronic headache
Patient Data
Marked supratentorial ventricular dilatation with no evidence of transependymal CSF permeation, associated with narrowed mamillopontine distance about 6 mm, consistent with compensated marked hydrocephalus.
Marked funneling of the proximal aqueduct with tight stenosis of its lower end. The 4th ventricle is not dilated, reflecting marked aqueduct stenosis.
Ultra-thin 3D sagittal T2 weighted images show marked aqueduct stenosis by adhesions/web.
Mild vertebrobasilar dolecho-ectasia identified.
Incidental bilateral maxillary sinusitis.
CSF flow study with phase-contrast imaging revealed:
- no flow across the aqueduct
- defect in the floor of the 3rd ventricle, with the presence of bidirectional flow across it denoting spontaneous third ventriculostomy, partially compensating the obstructive hydrocephalus
Case Discussion
This case shows severe aqueductal stenosis, resulting in evident supratentorial hydrocephalus, partially compensated by spontaneous third ventriculostomy.
Spontaneous third ventriculostomy is a rare finding in patients with chronic obstructive hydrocephalus where the ventricular system opens into the subarachnoid space, resulting in decreased symptoms of chronic hydrocephalus.
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