PATHOLOGICAL VARIATIONS  ENDOSCOPICALLY DETECTED

VARIANTI PATOLOGICHE  RILEVATE IN ENDOSCOPIA 

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 anatomia normale 

Malformations

This picture shows the appearance  of the monroi foramen  in a patient affected by myelomeningocoele.The foramen  seems divided in two partand You could  be disoriented  in defining which is the correct way to reach the third ventricle...

This particular aspect is due to an exceedingly high adhesio  which  actually divides the monroi  foramen in a posterior part  with the choroidal plexus  and an anterior  part without them...

Hydrocephalus in myelomeningocoele: the anterior part of the third ventricle seen from above and behind   .  This is a good example  of how advantageous is  an extensive knowledge  othe normal anatomy!

Hydrocephalus in myelomeningocoele 

malformed part of the anterior third ventricle. Mammillary bodies can not be identified 

Just anteriorly to the mammillary body  the apex of the basilar artery (or P1) may herniate  through the attenuated floor of the third ventricle

Long lasting hydrocephalic dilatation

                inf.             infundibulum

                tub.            cin.tuber cinereum

                a.b.            arteria basilaris (translucent) 

                p1.             arteria cerebri posterior 

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idem  particolare

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Intraventricular hemorrhages

2months infant with  post hemorrhagic hydrocephalus and  trapped fourth ventricle 

The cloth obstructing the acquaeduct is removed,  but underneath  a membrane has developped  and  is perforated 

final result after acquaeductoplasty

Posthemorrhagic modifications  of the internal surface of the ventricles  are characteristic  and very common  in paediatric patients.  The ependimal layer reacts to the deposit of  small particles of metahemoglobin  with  the production of a protective membrane. The nature of which is quite similar to the structure of the arachnoid. So upon the inner surface of the lateral ventricles  a web is stretched  which  hides quite every structure  and the foramen of MONRO itself.  Yet if  this membrane is teased a little bit, you will find  the normal ependimal laye. If  csf  flows  between  these layers and  ependyma  it can accumulate and  it can cause a cyst.  Many of these enlarged cysts cause the so-called pluriseptaded hydrocephalus;

 2months olf infant  with posthemorrhagic hydrocephalus and trapped fourth ventricle 

Posthemorrhagic hydrocephalus changes the normal anatomy of the cerebral ventricles, the scene  become  unfamiliar  and easily one can get lost. When Choroid plexus  are concealed  by membranes  the optostriate sulcus andparticularly the convergence of  the three main vein ( thalamostriate, septal, caudate) toward the foramen of monro  can be of great valuein orientingthe neurosurgeon