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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(09): 638-639
DOI: 10.1590/0004-282X20180084
Images In Neurology

Suprapineal recess diverticulum of the third ventricle exerting a mass effect on the midbrain and cerebellum

Divertículo do recesso suprapineal do terceiro ventrículo: efeito de massa sobre o mesencéfalo e cerebelo
Mariana Athaniel Silva Rodrigues
1   Hospital Israelita Albert Einstein, São Paulo SP, Brazil;
,
Thiago Pereira Rodrigues
2   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
,
Marcos Devanir Silva da Costa
2   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
,
Samuel Tau Zymberg
2   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
,
Ítalo C. Suriano
2   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
,
Sérgio Cavalheiro
2   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
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Ventricular diverticula usually occur secondary to chronic obstructive hydrocephalus, due to long-standing pulsating of cerebrospinal fluid against the ventricle wall[1],[2]. The medial wall of the atrium is more frequently involved[1],[3],[4], but other ventricle sites are at risk as well[2]. We report on a 21-year-old woman with chronic headache and bilateral dysmetria. Magnetic resonance imaging showed a ventricular diverticulum on the posterior wall of the third ventricle with a cerebellar and midbrain mass effect ([Figures 1]-[4]). Her symptoms partially improved after endoscopic third ventriculostomy in the tuber cinereum region. Treatment of chronic hydrocephalus has been shown to improve the ventricular diverticulum symptoms in the patients in the literature[1],[2],[3],[4],[5].

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Figure 1 The preoperative axial T2-weighted fast spin echo imaging shows a large retromesencephalic cyst.
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Figure 2 The preoperative midline sagittal T2-weighted fast spin echo imaging shows the third ventricle posterior wall diverticulum exerting a mass effect on both the midbrain and cerebellum. Also, there is an obstruction point in the cerebral aqueduct.
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Figure 3 The preoperative coronal T2-weighted fast spin echo imaging at the level of the lateral ventricular atrium shows integrity of the medial wall of both lateral ventricular atria, suggesting that the posterior wall of the third ventricle is involved in this posterior fossa cyst genesis.
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Figure 4 The postoperative midline sagittal T2-weighted fast spin echo shows reduction of the cyst size. The posterior wall of the third ventricle is now visualized and is separated from the tentorium and tentorial face of the cerebellum. Also seen is the lamina terminalis, which forms the anterior wall of the third ventricle.


Publication History

Received: 28 April 2018

Accepted: 14 May 2018

Article published online:
22 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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