title: Syringomyelia associated with hydrocephalus and Blake's pouch cyst: case report.
abstract: METHODS
  This is a case report of a 37-year-old woman who sought treatment for a large syringomyelic cavitation extending from C3 to the entire medulla, a tetraventricular hydrocephalus, and a cystic cavitation in the posterior cranial fossa communicating with the fourth ventricle (Blake's pouch cyst). The patient underwent a decompressive craniectomy, a C1 laminectomy, and the opening of the cysts to enable communication with the subarachnoid spaces. After an initial period of symptom remission, reassured by the magnetic resonance images indicating a reduction of the syringomyelia, the patient's neurologic conditions deteriorated because of further dilation of the ventricular cavities, which was resolved by the insertion of a ventriculoperitoneal shunt.
  
  
  OBJECTIVE
  To suggest the treatment of choice in a patient with syringomyelia and hydrocephalus caused by Blake's pouch cyst.
  
  
  BACKGROUND
  Blake's pouch cyst is an entity often poorly understood, deriving from nonperforation of the primitive foramen of Magendie, causing a precarious equilibrium of the cerebrospinal fluid flow resulting from a defect in communication between the fourth ventricle and the encephalic and spinal subarachnoid spaces. Authors report the association of Blake's pouch cyst with cervicodorsal syringomyelia and tetraventricular hydrocephalus.
  
  
  METHODS
  A case of syringomyelia associated with hydrocephalus and Blake's pouch cyst is described.
  
  
  RESULTS
  Symptoms of syringomyelia and hydrocephalus disappeared only after positioning of a ventriculoperitoneal shunt.
  
  
  CONCLUSIONS
  The treatment of choice for a case of syringomyelia associated with Blake's pouch cyst and hydrocephalus is the application of a ventriculoperitoneal shunt or, even better, an endoscopic third ventriculostomy.
authors.affiliation: Department of Neuroscience and Neurosurgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Conti
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Lunardi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bozzao
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liccardo
authors.forename: Bernardo
authors.initials: B
authors.lastname: Fraioli
mesh_terms: D000328:Adult; D016080:Arachnoid Cysts / Q000150:complications* / Q000601:surgery; D001247:Asthenia / Q000209:etiology; D001416:Back Pain / Q000209:etiology; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D007796:Laminectomy / Q000379:methods; D010292:Paresthesia / Q000209:etiology; D013595:Syringomyelia / Q000209:etiology*; D017287:Ventriculoperitoneal Shunt