Pediatric Aqueductal Stenosis

  • Etiology: Congenital narrowing of the cerebral aqueduct of Sylvius due to aqueductal web or gliosis
  • Imaging: Enlargement of lateral and third ventricles and normal size fourth ventricle
  • DDX:
  • Complications: If shunted and drained too quickly can get subdural hygromas
  • Treatment: Endoscopic third ventriculostomy or ventriculoperitoneal shunt
  • Clinical: Most common cause of congenital obstructive hydrocephalus

Radiology Cases of Aqueductal Stenosis

US of aqueductal stenosis
Coronal (left) and sagittal (right) US of the brain show dilation of the lateral and third ventricles. The fourth ventricle is normal in size.
US of aqueductal stenosis
Coronal (above) and sagittal (below) US of the brain show dilation of the lateral and third ventricles. The fourth ventricle is normal in size.
MRI of aqueductal stenosis
Axial (above left) and coronal (above right) T1 MRI without contrast of the brain show dilation of the lateral and third ventricles. Sagittal T2 MRI without contrast of the brain (below) shows narrowing at the aqueduct of Silvius with a decreased amount of CSF within it. The fourth ventricle is normal in size.
Radiograph and CT of copper beaten skull
AP and lateral radiographs of the skull (above) show throughout skull vault prominence of convolutional markings from gyral impressions on the inner table of the skull, which is also well demonstrated on the axial CT without contrast of the brain (below).