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Intraparenchymal ventricular diverticula in chronic obstructive hydrocephalus: prevalence, imaging features and evolution

  • Clinical Article - Pediatrics
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Abstract

Background

Intraparenchymal cavities communicating with the ventricles may appear in patients with chronic obstructive hydrocephalus despite no identifiable surgerical, vascular or traumatic causes. The rate, features, pathogenesis, evolution and clinical impact of intraparenchymal diverticula have not been outlined, yet.

Methods

Brain MRIs of 130 patients (mean age: 11.3 years; age range: 0–67; 60 females) with chronic obstructive hydrocephalus were analyzed. The pathogenesis, neurosurgical treatment, ventricle size, signs of transependymal reabsorption and septum pellucidum integrity of the hydrocephalus were recorded. Subarachnoid outpouching of the ventricles, post-hemorrhagic parenchymal cavities, paths of ventricular shunting and cavities not communicating with the ventricles were excluded. Of patients with intraparenchymal diverticula, all previous available CT and MRI scans were evaluated.

Results

Eight patients (6.2 %, mean age: 18.7 years; age range: 2–42) harbored 11 intraparenchymal diverticula sprouting from the temporal (6), occipital (3) or frontal (2) horns of the lateral ventricles. Intraparenchymal diverticula were more frequent in males (p = 0.04) and older patients (18.7 ± 12.7 vs 11.3 ± 9.8 years, p = 0.04). Their presence or evolution (mean neuroradiological follow-up 3.6 years; range: 0–8) showed a trend of association with hydrocephalus severity (bifrontal index) and did not correlate with the surgical treatment. In three patients the diverticula progressed during follow-up. One patient presented with hemiparesis consistent with the intraparenchymal lesion and improved after ventricular shunting. A DTI study revealed that the cortico-spinal tract was partly included in the septum between the ventricle and the intraparenchymal diverticulum.

Conclusions

Clinicians dealing with chronic severe obstructive hydrocephalus should be aware of ventricular intraparenchymal diverticulation. Studies aiming at clarifying their pathogenesis and proper management are warranted.

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Conflicts of interest

The author(s) declare that they have no competing interests.

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Authors and Affiliations

  1. Neuroradiology, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy

    Renzo Manara & Francesco Di Salle

  2. IRCCS S. Camillo, via Alberoni 70, 30011, Lido di Venezia, Italy

    Valentina Citton

  3. Department of Pediatrics, University of Padua, via Giustiniani 1, 35138, Padua, Italy

    Annalisa Traverso & Stefano Sartori

  4. Neuroradiology, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy

    Maria Chiara Zanotti, Francesco Bona & Giuseppe Rolma

  5. Neurosurgery, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy

    Roberto Faggin, Riccardo Perini & Marta Rossetto

  6. Department of Neuroscience, University of Padua, via Giustiniani 1, 35138, Padua, Italy

    Laura Milanese & Domenico d’Avella

  7. Neurology, University of Padua, via Giustiniani 1, 35138, Padua, Italy

    Chiara Briani

  8. Radiology, Ospedale S. Bassiano, via dei Lotti 40, 36061, Bassano del Grappa, VI, Italy

    Fabio Zerbo

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  1. Renzo Manara
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  2. Valentina Citton
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  3. Annalisa Traverso
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  4. Maria Chiara Zanotti
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  7. Riccardo Perini
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  8. Laura Milanese
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  9. Chiara Briani
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  10. Francesco Bona
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  11. Giuseppe Rolma
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  12. Marta Rossetto
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  13. Fabio Zerbo
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  14. Francesco Di Salle
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  15. Domenico d’Avella
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Corresponding author

Correspondence to Renzo Manara.

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Manara, R., Citton, V., Traverso, A. et al. Intraparenchymal ventricular diverticula in chronic obstructive hydrocephalus: prevalence, imaging features and evolution. Acta Neurochir 157, 1721–1730 (2015). https://doi.org/10.1007/s00701-015-2540-3

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  • DOI: https://doi.org/10.1007/s00701-015-2540-3

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