Spontaneous third ventriculocisternostomy in an infant with obstructive hydrocephalus

Spontaneous ventriculocisternostomy, the spontaneous communication between the ventricular system and the subarachnoid space, is rare. The authors report a case of an infant with obstructive hydrocephalus who developed a spontaneous third ventriculocisternostomy. The infant was initially evaluated for progressive ventriculomegaly and increasing head circumference (HC). During follow-up, the patient's HC began to follow percentile lines and magnetic resonance (MR) imaging demonstrated a reduction of the hydrocephalus. Flow-sensitive phase-contrast cine MR images revealed cerebrospinal fluid (CSF) flow through the floor of the third ventricle between the tuber cinereum and the mammillary bodies connecting the ventricular system with the prepontine cistern. Although rare, clinicians should be cognizant of this phenomenon as it may eliminate the need for CSF diversion.