|Year : 2015 | Volume
| Issue : 2 | Page : 89-92
Third and Fourth Cerebral Ventricular Sizes among Normal Adults in Zaria-Nigeria
Ahmed Umdagas Hamidu1, Solomon Ekott David2, Sefiya Adebanke Olarinoye-Akorede1, Barnabas Danborno2, Abdullahi Jimoh3, Olaniyan Fatai4
1 Department of Radiology, Ahmadu Bello University, Ahmadu, Zaria, Nigeria
2 Department of Human Anatomy, Ahmadu Bello University, Ahmadu, Zaria, Nigeria
3 Department of Neurosurgery, Ahmadu Bello University Teaching Hospital, Ahmadu, Nigeria
4 Department of Family Medicine, Ahmadu Bello University Teaching Hospital, Ahmadu, Zaria, Nigeria
|Date of Submission||09-Oct-2014|
|Date of Acceptance||18-Feb-2015|
|Date of Web Publication||20-May-2015|
Dr. Sefiya Adebanke Olarinoye-Akorede
Department of Radiology, Ahmadu Bello University, Ahmadu, Zaria
Introduction: The cerebrospinal fluid within the ventricles could be in excess or markedly reduced, and these could be the only sign of an intracranial or intraventricular disease. The linear dimensions of the 3 rd and 4 th cerebral ventricles are key to some of these findings. The practice of using the reviewer's experience or observing a change in the shape of the ventricles can be very subjective, hence the need for normal values. Objective: To establish linear dimensions of the 3 rd and 4 th cerebral ventricles among normal adults in Zaria using computer tomography. Materials and Methods: Axial computerized tomographic brain scans of the 488 normal subjects reviewed were acquired during a 3 year period (2009-2012) using a multi-slice GE Sigma excite scanner in our department, and the images were reviewed retrospectively. We obtained the widest linear dimensions of the 3 rd and 4 th cerebral ventricles using the in-built linear calipers of the computer tomography (CT) scan machine for each patient. Statistical analysis was performed using Sigmastat 2.0 for Windows (Statsoft, San Rafael, CA). The following statistical tests employed: students t-test and analysis of variance, and a probability level of <0.001 taken as statistically significant. Results: The 488 brain CT scans analyzed for this study comprised of 319 (65.36%) males and 169 (34.63%) females. The ages ranged from 18 to 84 years with a mean age of 37.26 years. The age difference between males and females were statistically significant. The mean 3 rd ventricular widths were 4.23 ± 1.25 and 3.81 ± 0.87 in males and females respectively, whereas the mean 4 th ventricular widths were, 7.87 ± 1.30 and 7.54 ± 1.33, in males and females, respectively. Conclusion: In this study, we have established normal linear values for the 3 rd and 4 th cerebral ventricles in Zaria using computed tomography. These values could serve as a quick reference for radiologists and neurosurgeons, obviating the need for advanced software packages, which may not be readily available.
Keywords: 3 rd and 4 th ventricles, computerized tomography, normal adults
|How to cite this article:|
Hamidu AU, David SE, Olarinoye-Akorede SA, Danborno B, Jimoh A, Fatai O. Third and Fourth Cerebral Ventricular Sizes among Normal Adults in Zaria-Nigeria. Sub-Saharan Afr J Med 2015;2:89-92
|How to cite this URL:|
Hamidu AU, David SE, Olarinoye-Akorede SA, Danborno B, Jimoh A, Fatai O. Third and Fourth Cerebral Ventricular Sizes among Normal Adults in Zaria-Nigeria. Sub-Saharan Afr J Med [serial online] 2015 [cited 2019 Mar 20];2:89-92. Available from: http://www.ssajm.org/text.asp?2015/2/2/89/157432
| Introduction|| |
Medical imaging is employed to describe the anatomy of deep structures within body cavities for descriptive or diagnostic purposes. To subject normal individuals to computerized tomography (CT) just to measure the sizes of the third (3V) and fourth (4V) cerebral ventricles may not be justifiable because of the radiation exposure involved. However, it is important to know the normal values of the sizes of the third and fourth ventricles. This will enable early detection of changes due to intrinsic and extrinsic pathology. It is also important to monitor and evaluate response to therapy in patients being treated for hydrocephalus. In the past, older encephalographic techniques including air or contrast medium were done, , which could be indirect and invasive. Later came polaroid pictures. The use of ultrasound is mostly applicable to children and post craniotomy, which serves a window for ultrasound. However in recent times, CT and magnetic resonance imaging (MRI) produce cross-sectional image with a direct view of the ventricular system, and make possible direct linear measurement. 
The grotesque appearance of craniofacial disproportion in childhood hydrocephalus has led to various studies of ventricular sizes mostly in children. In adults on the other hand because of fused sutures, the appearance is less dramatic, even though, the long-term effects can be distressful, hence fewer reports.
Age, sex, and body mass index (BMI) are known to affect ventricular dimensions.  It is also likely that in our environment, with added effects of previous childhood cerebral atrophy from cerebral malaria, meningitis, sickle cell cerebral syndrome, and cerebral palsy, that the sizes of the 3 rd and 4 th ventricles could differ from previous reports where these conditions are not as prevalent.
The aim of this study was to establish a normogram for the 3 rd and 4 th ventricular widths using CT scans in normal adult Nigerians.
| Materials and Methods|| |
Ethical consideration does not permit that healthy individual with no clinical manifestation to be subjected to ionizing radiation. Therefore, CT scans of neurologic patients, which were reported to be normal were reviewed for this study. Being a retrospective study, patient consent was not required,  however; this research was approved by the ethics committee of Ahmadu Bello University Teaching Hospital.
A total of 488 patients were chosen and analyzed for this study. They consisted of 319 males and 169 females age ranged between 18 and 84 years old. We excluded patients with any history, clinical or imaging findings intracranial or intraventricular pathology. Patients with a history of trauma, previous or present stroke were also excluded.
Procedure and Imaging Measurements
Computer tomography images were obtained from the local database of the CT machine and backup compact discs from the CT archives covering a 3 year period of this study (2009-2012). All patients had two-phase examination (pre and post contrast studies) using the department's Siemens CT scanner (Sigma Excite HD) at 2 mm slice thickness at the skull base and 5 mm subsequently through to the vertex. The images were viewed on the computer monitor, and the measurements were taken with in-built linear calipers.
The widest diameter of the third and fourth ventricles on axial images using a linear approach were measured [Figure 1] and [Figure 2]. The averages of the two measurements were recorded for each patient.
|Figure 1: Axial computer tomography image at the level of the third ventricle, showing how the measurement was taken|
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|Figure 2: Axial computer tomography image at the level of the fourth ventricle showing how the measurement was taken|
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Data were displayed in tables, expressed as simple percentages, means and standard deviation. Differences in ventricular size according to sex were examined using a Student's t-test. One-way analysis of variance was used to check for differences in some ventricular dimensions across age group. The statistical analyses were performed using Sigmastat 2.0 for Windows (Statsoft, San Rafael, CA). All significance tests were two-sided, and probability level below 0.05 was considered statistically significant.
| Results|| |
In our study, the youngest patient was 18 years old, whereas the oldest was 84 years old (mean age 37.26 years); 34.63% were females and 65.36% males [Table 1].
The mean third and fourth ventricular sizes were greater in males as compared to females although this difference was statistically significant only for the third ventricle. The differences in age among males and females were also statistically significant [Table 2].
For the total population, the mean dimension for the third and fourth ventricles were 4.09 ± 1.16 and 7.72 ± 1.66, respectively [Table 2].
The highest of the dimensions in the 3V and 4V occur in the highest age group of ≥60 years in both males and females [Table 3].
|Table 3: 3rd and 4th ventricular dimensions based on age groupings in males and females|
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| Discussion|| |
Our study shows that 3V and 4V dimensions as measured on CT of normal adult Nigerians in Zaria demonstrated sexual dimorphism in the studied population. The ventricular dimensions are reportedly higher (larger) in males than in females. ,,, This variation of ventricular sizes with sex was observed by Skullerud  and Gyldensted,  who documented that there are variations in the human brain, occasioned by differences in age, sex, and BMI and that these differences all have considerable effects on ventricular sizes. Women were found to have smaller brains and lateral ventricles than men even when the difference in height is taken into account. They observed that this difference was in proportion to the smaller size of the female cerebral hemispheres. The age difference among males and females in this study was statistically significant, and this could also account for the difference in their ventricular sizes.
Normal sizes of the ventricles on CT and MRI shows the 3V to be <5 mm in children, <7 mm in adults <60 years of age and <9 mm in adults above 60 years. 
The highest of the dimensions in the 3V and 4V occurred in the highest age group of ≥60 years. This confirms that ventricular dimensions increase in size with increasing age. This agrees with Celik et al. who examined 100 voluntary individuals with no physical or neurological deficit and he discovered that the sizes of the cerebral ventricles increase with age in both sexes. 
Furthermore, Skullerud  observed that there is a reduction in brain weight, which probably starts after the age of 55 years. This shrinkage, he stated increases in ventricular sizes as a compensatory mechanism to cerebral atrophy, which occurs as a physiological process following aging.
When compared with the study by different authors who are mainly Caucasians, there is no significant racial difference in the sizes of the ventricles. The present author  in a study of CT changes in childhood seizures found out that cerebral atrophy and enlarged ventricles to be the most common findings. It is thought that this could persist in adulthood and perhaps such children would have larger ventricular sizes in adulthood. As collaborated by Abidoye,  and Scrimshaw,  children who suffered from malnutrition are more likely to show growth retardation, difficulty in school and may remain malnourished up to adulthood. This could however not be ascertained by the present study, but would be a basis for a future study.
In conclusion, normal 3V and 4V sizes have been obtained in order to serve as a normogram in our environment as there is no study of such to the best knowledge of the authors.
| References|| |
Evans W. An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry 1942;47:931-7.
Gawler J, Du Boulay GH, Bull JW, Marshal J. Computerized tomography (the EMI Scanner): A comparison with pneumoencephalography and ventriculography. J Neurol Neurosurg Psychiatry 1976;39:203-11.
Skullerud K. Variations in the size of the human brain. Influence of age, sex, body length, body mass index, alcoholism, Alzheimer changes, and cerebral atherosclerosis. Acta Neurol Scand Suppl 1985;102:1-94.
Schroter S, Plowman R, Hutchings A, Gonzalez A. J Med Eth 2006;32:728-3.
Sabatini L. Evaluation and measurement of the normal ventricular and subarachnoid spaces by CT. Neuroradiology 1982,23:1-5.
Allen JS, Damasio H, Grabowski TJ. Normal neuro anatomical variation in the human brain: An MRI-volumetric study. Am J Phys Anthropol 2002;118:341-58.
Gyldensted C, Kosteljanetz M. Measurements of the normal ventricular system with computer tomography of the brain: A preliminary study on 44 adults. Neuroradiology 1976;10:205-13.
Meese W, Kluge W, Grumme T, Hopfenmtiller W. CT evaluation of the cerebrospinal fluid spaces of healthy persons. Neuroradiology 1980;19:131-6.
Celik HH, Gürbüz F, Erilmaz M, Sancak B. CT measurement of the normal brain ventricular system in 100 adults. Kaibogaku Zasshi 1995;70:107-15.
Wammanda RD, Chom ND, Hamidu AU. Computerized tomographic changes in children with neurological diseases in Zaria. Niger J Clin Prac 2009;12:25-8.
Abidoye RO, Eze DI. Comparative school performance through better health and nutrition in Nsukka, Enugu, Nigeria. Nutr Res 2000;20:609-20.
Scrimshaw NS. Malnutrition brain development, learning and behaviour. Nutr Res 1998;18:351-79.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]