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Year : 2001  |  Volume : 49  |  Issue : 4  |  Page : 415

Retrograde cerebrospinal fluid metastasis in a vermian medulloblastoma.

How to cite this article:
Chagla A, Muzumdar D P. Retrograde cerebrospinal fluid metastasis in a vermian medulloblastoma. Neurol India 2001;49:415

How to cite this URL:
Chagla A, Muzumdar D P. Retrograde cerebrospinal fluid metastasis in a vermian medulloblastoma. Neurol India [serial online] 2001 [cited 2020 Oct 26];49:415. Available from:

A 10 year old child presented with excruciating bifrontal headache, vomiting and unsteadiness of gait for three months. On admission, he was conscious and oriented but extremely irritable. Fundus showed bilateral optic atrophy. He had left lateral gaze paresis and mild left lower motor neuron facial palsy. He had mild gait ataxia. Brain CT showed a well circumscribed, uniformly isodense, homogenously enhancing large vermian tumour extending into left cerebellopontine angle [Figure - 1]. A small portion of dilated fourth ventricle is seen anterior and superior to the tumour along with dilated aqueduct and distended third and lateral ventricles. Additional two separate isodense well enhancing tumours are seen; one in the posterior third ventricle in the region of the suprapineal recess [Figure. 2] and the second in floor of the third of the ventricle which obliterates all the suprasellar cisternal space [Figure. 1]. There is mild periventricular lucency surrounding both lateral ventricles. All cortical sulci are effaced and ambiens cisterns are compressed. Patient underwent a midline posterior fossa craniectomy with radical excision of the cerebellar tumour. Histopathology revealed medulloblastoma. This patient had obstructive hydrocephalus due to the cerebellar tumour which probably resulted in a spontaneous third ventriculostomy. Tumour seedlings have therefore spread in a retrograde manner and caused two separate masses, one in the posterior third ventricle and other in the floor of the third ventricle and suprasellar cistern. Spontaneous third ventriculostomy has been described by Torkildsen with rupture in the posterior wall of the third ventricle and cyst formation in the interpeduncluar sapce.[1] Tandon and Harkmark have reported a case of a brainstem tumour obliterating the fourth ventricle with a spontaneous rupture of a suprapineal recess into the quadrigeminal cistern.[2]

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1.Torkildsen A : Spontaneous rupture of the cerebral ventricles. J Neurosurg 1948; 5 : 327-339.   Back to cited text no. 1    
2.Tandon PN, Harkmark W : Spontaneous ventriculostomy with relief of obstructive hydrocephalus. Neurology 1959; 9 : 699-703.   Back to cited text no. 2    


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