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Fourth ventricular outlet obstruction

25 year old patient presented with headache and vomitting of few days duration. MRI showed obstructive hydrocephalus with dilatation of all the ventricles and ballooned out fourth ventricle. This was suggestive of fourth ventricular outlet obstruction. The patient underwent Endoscopic Third Ventriculostomy to relieve the obstruction. Patient recovered well and follow up CT shows completely decompressed fourth ventricle.
Endoscopic third ventriculostomy (ETV) is a very good surgical method to relieve obstructive hydrocephalus. It avoids the need of shunt and its associated problems.

Sagittal MRI with dilatation of lateral and fourth ventricular

Dilatation of lateral and third ventricle

Follow up CT scan with normal sized fourth ventricle