Raumforderungen und Fehlbildungen des III. Ventrikels: anatomische Normalverhältnisse und Differenzialdiagnose^[1]

Zusammenfassung

Der III. Ventrikel liegt im Zentrum des Gehirns. Er ist von empfindlichen Kernstrukturen (Hypothalamus und Thalami) sowie wichtigen Drüsen (Hypophyse und Zirbeldrüse) umgeben. Es gibt viele verschiedene pathologische Prozesse, die den III. Ventrikel involvieren können, wobei extrinsische Raumforderungen am häufigsten sind. Mit entsprechenden Kenntnissen der anatomischen Grenzen des III. Ventrikels und seiner Beziehung zu angrenzenden Strukturen lassen sich relevante Differenzialdiagnosen erstellen. Raumforderungen des III. Ventrikels werden anhand ihres Ursprungs oder ihrer Lage in 5 Kategorien unterteilt: anterior, posterior, inferior, am Foramen interventriculare und intraventrikulär. Anteriore Raumforderungen involvieren den Recessus supraopticus und den Recessus infundibularis, posteriore Raumforderungen wachsen in der oder betreffen die Commissura posterior und die Zirbeldrüse. Inferiore Raumforderungen involvieren oder betreffen den Ventrikelboden. Raumforderungen können auch am oder nahe dem Foramen interventriculare entspringen oder als intraventrikuläre Raumforderung gänzlich im III. Ventrikel liegen. Das Chordoidgliom, eine seltene, niedriggradige Primärneoplasie, gehört zu den intraventrikulären Raumforderungen und kommt nur im III. Ventrikel vor. Angeborene Fehlbildungen des III. Ventrikels sind selten und werden meistens während der Kindheit entdeckt. Die meisten dieser Anomalien sind Malformationen der Neurohypophyse, die sich als Hormonstörungen manifestieren, oder Stenosen des Aquädukts, die zu einer Erweiterung des III. Ventrikels und der Seitenventrikel (Hydrozephalus) führen.

Abstract

The third ventricle lies in the center of the brain. It is surrounded by critical nuclear structures (the hypothalamus and thalami) and important glandular structures (the pituitary and pineal glands). Although a wide array of pathologic processes may involve the third ventricle, most are extrinsic masses. By understanding the anatomic boundaries of the third ventricle and its relationship to adjacent structures, it is possible to create short lists of differential diagnoses. Third ventricle masses can be classified as arising in or immediately adjacent to one of five locations: anterior, posterior, inferior, foramen of Monro, and intraventricular. Anterior masses involve the optic and infundibular recesses, posterior masses affect or arise in the posterior commissure and pineal gland, and inferior masses involve or affect the ventricle floor. Masses may also arise at or adjacent to the foramen of Monro or entirely within the third ventricle. Of the intraventricular masses, chordoid glioma – a rare low-grade primary neoplasm – is unique to the third ventricle. Congenital malformations of the third ventricle are uncommon and are most often noted during childhood. Most commonly, these anomalies represent malformations of the neurohypophysis, which may manifest as hormonal abnormalities, or stenosis of the aqueduct of Sylvius, which manifests as dilatation of the third and lateral ventricles (hydrocephalus).

¹ © 2011 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2011; 31: 1889 – 1905. Online published in 10.1148 /rg.317115083. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

• Literatur

• 1 Harnsberger HR, Osborn AG, Macdonald AJ et al. Diagnostic and surgical imaging anatomy: brain, head and neck, spine. Salt Lake City, Utah: Amirsys; 2006: 49
• 2 Standring S. Development of the nervous system. In: Standring S, Ellis H, Healy JC, et al., eds. Gray’s anatomy. 39th. ed. London, England: Churchill Livingstone; 2005: 260-267
• 3 Standring S. Ventricular system and cerebrospinal fluid. In: Standring S, Ellis H, Healy JC, et al., eds. Gray’s anatomy. 39th. ed. London, England: Churchill Livingstone; 2005: 287-294
• 4 Tubbs RS, Louis Jr RG, Wartmann CT et al. The velum interpositum revisited and redefined. Surg Radiol Anat 2008; 30: 131-135
• 5 Wen HT, Rhoton Jr AL, de Oliveira E. Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application. Neurosurgery 1998; 42: 1205-1217 discussion 1217–1219
• 6 Kier LE. The evolutionary and embryologic basis for the development and anatomy of the cavum veli interpositi. AJNR Am J Neuroradiol 2000; 21 : 612-614
• 7 Wilder BG. The foramina of Monro: some questions of anatomical history. Boston Med Surg J 1880; 103: 152-154
• 8 Arvanitis LD, Sgantzos MN, Kotrotsios A et al. Congenital fusion of the thalami (atresia of the third ventricle) associated with parietooccipital meningocele. Pediatr Dev Pathol 2010; 13 : 419-422
• 9 Barkovich AJ. Hydrocephalus. In: Barkovich AJ, ed. Pediatric neuroimaging. 4th. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005: 659-703
• 10 Tisell M. How should primary aqueductal stenosis in adults be treated? A review.. Acta Neurol Scand 2005; 111 : 145-153
• 11 Moore KR. Aqueductal stenosis. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 20-23
• 12 Steno A, Popp AJ, Wolfsberger S et al. Persisting embryonal infundibular recess. J Neurosurg 2009; 110 : 359-362
• 13 D’Addario V, Pinto V, Rossi AC et al. Cavum veli interpositi cyst: prenatal diagnosis and postnatal outcome. Ultrasound Obstet Gynecol 2009; 34: 52-54
• 14 Osborn AG. Ependymal cyst. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 42-43
• 15 Vlaho S, Gebhardt B, Gerlach R et al. Cyst of the third ventricle as an unusual cause of acquired hydrocephalus. Pediatr Neurol 2003; 28 : 225-227
• 16 Oppido PA, Fiorindi A, Benvenuti L et al. Neuroendoscopic biopsy of ventricular tumors: a multicentric experience. Neurosurg Focus 2011; 30: E2
• 17 Steno J, Malácek M, Bízik I. Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 2004; 54: 1051-1058 discussion 1058-1060
• 18 Kollias SS, Barkovich AJ, Edwards MS. Magnetic resonance analysis of suprasellar tumors of childhood. Pediatr Neurosurg 1991; – 1992; 17: 284-303
• 19 Liang L, Korogi Y, Sugahara T et al. MRI of intracranial germ-cell tumours. Neuroradiology 2002; 44: 382-388
• 20 Barkovich AJ. Intracranial, orbital and neck masses of childhood. In: Barkovich AJ, ed. Pediatric neuroimaging. 4th. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005: 506-658
• 21 Johnsen DE, Woodruff WW, Allen IS et al. MR imaging of the sellar and juxtasellar regions. RadioGraphics 1991; 11: 727-758
• 22 Choi SH, Kwon BJ, Na DG et al. Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: differentiation using MRI. Clin Radiol 2007; 62: 453-462
• 23 Miller DC. Pathology of craniopharyngiomas: clinical import of pathological findings. Pediatr Neurosurg 1994; 21 : 11-17
• 24 Behari S, Banerji D, Mishra A et al. Intrinsic third ventricular craniopharyngiomas: report on six cases and a review of the literature. Surg Neurol 2003; 60 : 245-252 discussion 252–253
• 25 Smith AB, Rushing EJ, Smirniotopoulos JG. Lesions of the pineal region: radiologic-pathologic correlation. RadioGraphics 2010; 30: 2001-2020
• 26 Hirato J, Nakazato Y. Pathology of pineal region tumors. J Neurooncol 2001; 54: 239-249
• 27 Saleem SN, Said AH, Lee DH. Lesions of the hypothalamus: MR imaging diagnostic features. RadioGraphics 2007; 27: 1087-1108
• 28 Feng H, Huang G, Liao X et al. Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis. J Neurosurg 2004; 100: 626-633
• 29 Morota N, Watabe T, Inukai T et al. Anatomical variants in the floor of the third ventricle; implications for endoscopic third ventriculostomy. J Neurol Neurosurg Psychiatry 2000; 69: 531-534
• 30 Maeder PP, Holtås SL, Basibüyük LN et al. Colloid cysts of the third ventricle: correlation of MR and CT findings with histology and chemical analysis. AJNR Am J Neuroradiol 1990; 11: 575-581
• 31 Osborn AG. Colloid cyst. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 10-13
• 32 Adriaensen ME, Schaefer-Prokop CM, Stijnen T et al. Prevalence of subependymal giant cell tumors in patients with tuberous sclerosis and a review of the literature. Eur J Neurol 2009; 16: 691-696
• 33 Vezina G. Tuberous sclerosis complex. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 98-101
• 34 Im SH, Paek SH, Choi YL et al. Clinicopathological study of seven cases of symptomatic supratentorial subependymoma. J Neurooncol 2003; 61: 57-67
• 35 Salzman KL. Subependymoma. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 68-71
• 36 Koeller KK, Sandberg GD. Cerebral intraventricular neoplasms: radiologic-pathologic correlation. RadioGraphics 2002; 22: 1473-1505
• 37 Nakano I, Kondo A, Iwasaki K. Choroid plexus papilloma in the posterior third ventricle: case report. Neurosurgery 1997; 40: 1279-1282
• 38 Ho CY. Choroid plexus tumors. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 72-81
• 39 Osborn AG. Choroid plexus cyst. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 38-41
• 40 Rees JH. Chordoid glioma of the third ventricle. In: Osborn AG, Salzman KL, Barkovich AJ, eds. Diagnostic imaging: brain. 2nd. ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2010: 56-57
• 41 Vanhauwaert DJ, Clement F, Van Dorpe J et al. Chordoid glioma of the third ventricle. Acta Neurochir (Wien) 2008; 150: 1183-1191
• 42 Hauck EF, Vu L, Campbell GA et al. Intraventricular ganglioglioma. J Clin Neurosci 2008; 15: 1291-1293
• 43 Luther N, Souweidane MM. Neuroendoscopic resection of posterior third ventricular ependymoma: case report. Neurosurg Focus 2005; 18: E3
• 44 Ragel BT, Townsend JJ, Arthur AS et al. Intraventricular tanycytic ependymoma: case report and review of the literature. J Neurooncol 2005; 71: 189-193
• 45 Lee TT, Manzano GR. Third ventricular glioblastoma multiforme: case report. Neurosurg Rev 1997; 20: 291-294
• 46 Shelton 3rd CH, Phillips CD, Laws ER et al. Third ventricular lesion masquerading as suprasellar disease. Surg Neurol 1999; 51: 177-180