title: Intraparenchymal ventricular diverticula in chronic obstructive hydrocephalus: prevalence, imaging features and evolution.
abstract: BACKGROUND
  Intraparenchymal cavities communicating with the ventricles may appear in patients with chronic obstructive hydrocephalus despite no identifiable surgerical, vascular or traumatic causes. The rate, features, pathogenesis, evolution and clinical impact of intraparenchymal diverticula have not been outlined, yet.
  
  
  METHODS
  Brain MRIs of 130 patients (mean age: 11.3 years; age range: 0-67; 60 females) with chronic obstructive hydrocephalus were analyzed. The pathogenesis, neurosurgical treatment, ventricle size, signs of transependymal reabsorption and septum pellucidum integrity of the hydrocephalus were recorded. Subarachnoid outpouching of the ventricles, post-hemorrhagic parenchymal cavities, paths of ventricular shunting and cavities not communicating with the ventricles were excluded. Of patients with intraparenchymal diverticula, all previous available CT and MRI scans were evaluated.
  
  
  RESULTS
  Eight patients (6.2 %, mean age: 18.7 years; age range: 2-42) harbored 11 intraparenchymal diverticula sprouting from the temporal (6), occipital (3) or frontal (2) horns of the lateral ventricles. Intraparenchymal diverticula were more frequent in males (p = 0.04) and older patients (18.7 ± 12.7 vs 11.3 ± 9.8 years, p = 0.04). Their presence or evolution (mean neuroradiological follow-up 3.6 years; range: 0-8) showed a trend of association with hydrocephalus severity (bifrontal index) and did not correlate with the surgical treatment. In three patients the diverticula progressed during follow-up. One patient presented with hemiparesis consistent with the intraparenchymal lesion and improved after ventricular shunting. A DTI study revealed that the cortico-spinal tract was partly included in the septum between the ventricle and the intraparenchymal diverticulum.
  
  
  CONCLUSIONS
  Clinicians dealing with chronic severe obstructive hydrocephalus should be aware of ventricular intraparenchymal diverticulation. Studies aiming at clarifying their pathogenesis and proper management are warranted.
authors: Neuroradiology, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy. rmanara@unisa.it.
authors: Renzo
authors: R
authors: Manara
authors: IRCCS S. Camillo, via Alberoni 70, 30011, Lido di Venezia, Italy.
authors: Valentina
authors: V
authors: Citton
authors: Department of Pediatrics, University of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Annalisa
authors: A
authors: Traverso
authors: Neuroradiology, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Maria Chiara
authors: MC
authors: Zanotti
authors: Neurosurgery, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Roberto
authors: R
authors: Faggin
authors: Department of Pediatrics, University of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Stefano
authors: S
authors: Sartori
authors: Neurosurgery, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Riccardo
authors: R
authors: Perini
authors: Department of Neuroscience, University of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Laura
authors: L
authors: Milanese
authors: Neurology, University of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Chiara
authors: C
authors: Briani
authors: Neuroradiology, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Francesco
authors: F
authors: Bona
authors: Neuroradiology, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Giuseppe
authors: G
authors: Rolma
authors: Neurosurgery, University Hospital of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Marta
authors: M
authors: Rossetto
authors: Radiology, Ospedale S. Bassiano, via dei Lotti 40, 36061, Bassano del Grappa, VI, Italy.
authors: Fabio
authors: F
authors: Zerbo
authors: Neuroradiology, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
authors: Francesco
authors: F
authors: Di Salle
authors: Department of Neuroscience, University of Padua, via Giustiniani 1, 35138, Padua, Italy.
authors: Domenico
authors: D
authors: d'Avella
mesh_terms: D000293:Adolescent; D000328:Adult; D002552:Cerebral Ventricles / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004240:Diverticulum / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000000981:diagnostic imaging; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: DTI; Hydrocephalus; MRI; Ventricular diverticulum