|Year : 2013 | Volume
| Issue : 3 | Page : 83-86
Morphological variation of third ventricle using computerized tomography among different gender and age groups: A 5-year retrospective study in Usmanu Danfodiyo University Teaching Hospital, Sokoto, North - West Nigeria
JD Usman1, AD Zagga1, AA Tadros1, G Yunusa2, SA Saidu2, H Ahmed3, SS Bello1, A Abdulhameed1, SM Bello1, A Bello1
1 Department of Anatomy, Collage of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Radiology, Collage of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
3 Department of Paediatrics, Collage of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
|Date of Web Publication||22-Nov-2013|
S S Bello
Department of Anatomy, Collage of Health Science, Usmanu Danfodiyo University, Sokoto
Background: Many methods have been described for measurements of the third ventricle as a means of evaluating brain atrophy during the normal aging process and disease. Enlargement of the cerebral ventricles is one of the most frequently replicated neurobiological findings in schizophrenia. The aim of this morphological study was to examine the range in the normal size of the third ventricle of individuals living in Sokoto and to assess its association with gender and age. Materials and Methods: All available brain CT in the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, from 2007 to 2012 (a 5-year period) and reported as normal by the radiologist were recruited for the study. Films were viewed on the computer monitor. Measurements were made with Dragon V 3.1.1 Philips and Neusoft Medical System Company Limited software; the software provides a meter rule with which measurements were done. Results: A total of 252 CT scan images where used in the study. Of this number, 156 (61.9%) were CT scan images of males and 96 (38.1%) were CT scan images of females. The mean width was 8.38 mm and mean anteroposterior length was 12.16 mm. These differences were statistically significant, P = 0.0209 < (0.05). Conclusion: Our findings provide a base line data for the measurement of the third ventricles using CT scans in our environment and this may be applied in various clinical conditions involving the third ventricle.
Keywords: Cephalometry, computerized tomography, Nigeria, Sokoto, third ventricles
|How to cite this article:|
Usman J D, Zagga A D, Tadros A A, Yunusa G, Saidu S A, Ahmed H, Bello S S, Abdulhameed A, Bello S M, Bello A. Morphological variation of third ventricle using computerized tomography among different gender and age groups: A 5-year retrospective study in Usmanu Danfodiyo University Teaching Hospital, Sokoto, North - West Nigeria. Sahel Med J 2013;16:83-6
|How to cite this URL:|
Usman J D, Zagga A D, Tadros A A, Yunusa G, Saidu S A, Ahmed H, Bello S S, Abdulhameed A, Bello S M, Bello A. Morphological variation of third ventricle using computerized tomography among different gender and age groups: A 5-year retrospective study in Usmanu Danfodiyo University Teaching Hospital, Sokoto, North - West Nigeria. Sahel Med J [serial online] 2013 [cited 2021 Jul 31];16:83-6. Available from: https://www.smjonline.org/text.asp?2013/16/3/83/121904
| Introduction|| |
The third ventricle, "ventricles tertius cerebri," is one of four connected, cerebrospinal fluid-filled cavities of the human brain.  Of all the methods used to investigate biological abnormalities in psychiatric illnesses, structural neuro- imaging studies have provided some of the most consistent evidence of brain abnormalities in schizophrenia.  The brain undergoes many gross changes with advancing age and in various dementias, with regression of the brain tissue leading to the enlargement of the third ventricle and rounding of the lateral ventricles.  This ballooning of the third ventricle was attenuated to the regression of the media nuclei of the thalami and a progressive diminution of the massa intermedia that joins them. 
Cotton et al. (2005) studied third ventriclar size in relation to cranial vault size and concluded that with advancing age there is gradual widening of the third ventricle.  Ventricular enlargement was described as a sensitive indicator of central nervous system pathology in various disorders. 
Enlargement of the cerebral ventricle is one of the most frequently replicated neurobiological findings in schizophrenia.  The enlarged lateral and third ventricles have been reported to be useful in evaluating patients with schizophrenia using CT images. 
This abnormality in some brain disorders has been demonstrated by the brain structure imaging techniques such as pneumoencephalography, CT, and magnetic resonance imaging. ,,
Davies using cranial ultrasound, in diagnosis and assessment of ventricular enlargement in preterm infants, reported that there was no gender variation in his study.  Medora and Prashant concluded in their CT-based study that the width of the third ventricle among females was 0.39 + 0.17 cm, smaller than the one recorded among males 0.45 + 0.29 cm. 
Schimmels studied the length of the third ventricle among infants with Trisomy and healthy control using ultrasound, and reported the length of the third ventricle of the control as 0.63 ± 0.3 cm and width as 0.19 ± 0.06 cm.  A comparison of the width of the third ventricle using CT scan among patients with multiple sclerosis and normal subjects revealed the width among the normal (normal) group to be 2.25 ± 0.82 mm. 
| Materials and Methods|| |
Selection of materials
All available brain CT scan of subjects done in the Radiology Department of the Usmanu Danfodio University Teaching Hospital (UDUTH) Sokoto, from 2007 to 2012 (a 5-year period) and reported as normal by the radiologist, were recruited for the study. The study involved normal subjects from birth to 70 years, categorized into groups of 0 -5 years, 6-10, 11-15 years, 16-20 years, 21- 25, and above 25 years.
The total number of CT scans of the brain done in the department during the study period was 2,545 out of which 926 scans were reported to have normal third ventricle. However, only 258 CT scans satisfied the inclusion criteria; 172 (66.67%) were CT scan images of males and 65 (33.33%) were CT scans images of females (M:F ratio = 2:1).
Only CT scans interpreted by experienced radiologists were studied. Thus, the CT scans for measurements were selected on the basis of good quality and having no visible evidence of pathology, which may affect the normal anatomy of third ventricle.
Two brain CT Scans showing pathological changes affecting the normal anatomy of the third ventricles were excluded. Seventeen films were excluded due to poor identification of reference points for measurement. Eleven brain CT scans with poor position of the patients and 38 brain CT scans with poor quality of scan images were excluded.
All the scans used for the study were done with the NEUSOFT C 3000 Spiral machine Dual Slide Helical CT (2005) model. Slide sections were cut at 3-5 mm. Contours and surface details were rendered in fine detail.
Brain CT Scans were obtained from the local data of the CT machine and back up compact disc from the CT library. Films were viewed on the computer monitor. The presence or absence of pathology was noted. Measurement was made as shown in [Figure 1] with Dragon V 3.1.1 Philips and Neusoft Medical System limited software; the software provides a meter rule with which measurements were done.
|Figure 1: A CT image of a 25 year old male showing measurement of the length of the third ventricle (A-B).|
Click here to view
Measurements were made on all the brain CT images at the level of interventricular foramen, where the whole extent of the third ventricle could be seen. The length or the antero-posterior diameter was obtained by measuring the distance from the lamina terminalis (A) to the posterior point on the posterior commissure (B). The width was measurement at the level of inter-thalamic adhesion.
Statistical tests were employed for data analysis. Continuous variables were analyzed using the Student test and expressed as mean ± (SD). A probability (P) < 0.05 was taken as significant. Analysis of data was done by SPSS 11.0 for Windows software program.
| Result|| |
The mean width observed was 8.3 ± 1.54 mm and mean length was 12.16 ± 2.31 mm. The mean width and length of the third ventricle in the males (5.25 ± 1.32 mm and 27.84 ± 1.53 mm) were greater than those of the females (5.34 ± 1.38 mm and 25.42 ± 1.43 mm) respectively and these differences were statistically significant, P = 0.0209 (<0.05). As shown on [Table 1] and [Table 2].
|Table 1: Antero-posterior length of third ventricle in male and female from 0 to >25 years of age|
Click here to view
|Table 2: Width of the third ventricle in males and females from 0 to >25 years of age|
Click here to view
| Discussion|| |
Surgery in the region of the third ventricle poses a considerable challenge, even for experienced neurosurgeons.  This study was tailored toward better understanding of the anatomy and to examine the normal range of sizes of third ventricle and assess their differences with respect to age and gender among the Nigerian population.
Mathew et al. (2012) in their study reported the antero-posterior length of the third ventricle as greater in males (31.33 ± 5.70 mm) than, among females (28.25 ± 2.44 mm) and the width of 5.38 ± 1.33 mm in males and 5.73 ± 1.61 mm in females with significant gender variation from 6 years and above.  This is slightly high than the values obtained in our study.
Schimmels et al. studied the length of the third ventricle among infants with Trisomy and healthy controls using ultrasound.  They measured the mean length of the control (normal) as 0.63 ± 0.3 cm and width as 0.19 ± 0.06 cm. In the present study only infant with normal CT scans had their reading recorded; the length obtained was 2.65 ± 2.89 mm among males and 2.2 ± 2.09 mm among females, respectively.
| Conclusion|| |
This study provides a base line data for the measurement of the length and width of the normal third ventricles using CT scans in our environment and this may be applied in various clinical conditions involving the third ventricle.
| References|| |
|1.||Berry M, Bannister LH, Scandring SM, Willing L, Lawrence H, Bannister LH, et al. Grays Anatomy. 38 th ed, Edinburgh London, Melbourne and Newyork: Chuchill Livingstone; 1995. p. 1202. |
|2.||Johnstone EC, Crow TJ, Frith CD, Husband J, Kreel L. Cerebral ventricle size and cognitive impairment in chronic schizophrenia. Lancet 1976;30:924-6. |
|3.||Schochet SS Jr. Neuropathology of ageing. Neurol Clin 1998;16:569-80. |
|4.||LeMay M. Radiology change of ageing brain and skull. Am J Roentogenol 1984; 83-9. |
|5.||Cotton F, Euvrard T, Durand-Dubief F, Pachai C, Cucherat M, Ramirez Rozzi F, et al. Correction between cranial vault swize and brain size over time preliminary MRI evaluation. J Neuroradiol 2005;32:131-7. |
|6.||Turner B, Ranil N, Blumhardt LD, Jaspan T. Ventricular enlargement in multiple sclerosis; A comparison of three - dimensional and linear MRI estimates. Neuroradiology 2001;43:608-14. |
|7.||Nasrallah HA, Jacoby CG, McCalley-Whitters M. Third ventricle enlargement on CT scans in Schizophrenia: Associated with cerebbellar atrophy. Biol Psychiatr 198520:443-50. |
|8.||Davies M, Swaminathan M, Chuang S, Betheras F. Reference ranges for linear dimensions of the intracnail ventricles in pretern newborns. Arch Dis Child Neonatal Ed 2000;82:F223. |
|9.||Medara DD, Prashant EN. Morphological study of the ventricular system of brain by computerized tomography. J Anat Soc India 2007:56:19-24. |
|10.||Schimmel MS, Hammerman C, Bromiker R, Berger I. Third ventricle enlargement among newborn infant with Trimony 21. Pediatrics 2006:117:c928-31. |
|11.||Benedict RH, Bruce JM, Dwyer MJ, Dwyer MG. Neocortical atrophy, third ventricle width and cognitive dysfunction in multiple sclerosis. Arch Neurol 2006:63:1301-6. |
|12.||Turnee U, Yasargil MG, Al-Mefty O. The transcallosal-transforaminal approach to the third ventricle with regard to the venous variation in this region. J Neurosurg 1997;87:706-15. |
|13.||Mathew LS, Paul M, Bakshi S. Assessment of third ventricle with MRI: Morphological variation among different gender and age group. Webmed Central ANATOMY 2012; 3:1-10. |
[Table 1], [Table 2]