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381
Brij et al., Int J Med Res Health Sci. 2014;3(2): 381-387
International Journal of Medical Research
&
Health Sciences
www.ijmrhs.com Volume 3 Issue 2 (April - Jun) Coden: IJMRHS Copyright @2014 ISSN: 2319-5886
Received: 14th Feb 2014 Revised: 13th Mar 2014 Accepted: 16th Mar 2014
Research Article
VENTRICLES OF BRAIN: A MORPHOMETRIC STUDY BY COMPUTERIZED TOMOGRAPHY
Brij Raj Singh1, Ujwal Gajbe1, Amit Agrawal2, *Anilkumar Reddy Y1, Sunita Bhartiya1
1Department of Anatomy, J.N.M.C, Sawangi, Meghe, Wardha, Maharashtra, India
2Dept of Neurosurgery, Narayana Medical College, Nellore, Andhra Pradesh, India
*Corresponding author email: kumarlucky48@gmail.com,
ABSTRACT
Introduction: As the human brain ages, characteristic structural changes occur that are considered to be normal
and are expected. Thus the thorough knowledge of the age related normal changes that occur in the brain is
required before any abnormal findings are analyzed. As ageing advances, the brain undergoes many gross and
histopathological changes with regression of the brain tissue leading to the enlargement of the ventricles.
To understand these changes the knowledge of normal morphometry and size of normal ventricular system of
brain is important. Materials & Methods: For the present study 358 (Males - 207 and Females - 151) individuals
Computerized Tomography (CT) images of brain studied. Measurements of fourth ventricle, third ventricle and
lateral ventricle were noted down from CT images and it was statistically analyzed. Results: After analysis it was
observed that the height and width of the fourth ventricle was larger in males as compared to females. The length
of the third ventricle was observed to be greater in females than in males. The width of the third ventricle it was
observed to be greater in males than in females. Antero-posterior extent of the left frontal horn (males = 26.26 ±
2.94, 95% CI 25.86 - 26.66 mm and females = 26.53 ± 3.38, 95% CI 25.99 - 27.08 mm) was greater than that of
the right ones (males = 25.00 ± 3.18, 95% CI 24.57 - 25.44 mm and females = 25.34 ± 3.50, 95% CI 24.78 - 25.90
mm). Conclusion: Advances in sensitive imaging techniques like the Computerized Tomography helps in
dramatic expansion of our understanding of the normal structure of brain. The present study has defined the
morphometric measurements of the lateral ventricles, third ventricle, and fourth ventricle of the brain which has
clinical correlations in diagnosis and for further line of treatment.
Keywords: ventricular system, morphometric study, human brain
INTRODUCTION
Man has long been fascinated with workings of
human brain. The structure of human brain is
complicated and not yet fully understood. As the
human brain ages, characteristic structural changes
occur that are considered to be normal and are
expected. Thus the thorough knowledge of the age
related normal changes that occur in the brain is
required before any abnormal findings are analyzed.
There have been a great number of studies examining
the anatomical structure of the human brain and the
age related changes that occur normally. As ageing
advances, the brain undergoes many gross and
histopathological changes with regression of the
brain tissue leading to the enlargement of the
ventricles.1Both imaging and autopsy studies
revealed that there is correlation with increase in
cerebrospinal fluid spaces and reduction in cerebral
volume accompanying normal human ageing.2, 3 Due
to these changes that occurs normally with ageing,
the diagnosis of diseases in elderly patients is often
DOI: 10.5958/j.2319-5886.3.2.079
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Brij et al., Int J Med Res Health Sci. 2014;3(2): 381-387
complicated. So, the two major changes that may
occur in elderly individual without neurologic deficits
is enlargement of ventricles and cortical atrophy.
However surprisingly, there is lack of clinical,
radiologic and pathologic information regarding these
changes in humans. The normal ventricular size
during life was previously unknown.
In the past, the pneumoencephalogram was the most
valuable test for determining ventricular size during
life. Advances in sensitive imaging techniques like
the Computerized Tomography helps in dramatic
expansion of our understanding of the normal
structure of brain without the use of contrast media.
Computerized Tomography also provided a
revolutionary means for morphologic study of the
brain in vivo. Some authors found gender differences
in brain atrophy with ageing and revealed that the
degree of change was milder in women than in men.5
Enlargement of cerebrospinal fluid spaces during
ageing is generally diffused.6There is regression of
thalamic nuclei after 50 years of age which explains
demonstration of early third ventricular enlargement.4
There is more shrinkage with age in the frontal
cortex, brain stem and dienchephalic structure7. Also
the left lateral ventricle is normally larger than the
right.8Various studies clearly shows an increase in
the CSF spaces in dementia especially in Alzheimer’s
disease and Parkinson’s disease.9This was due to
reduction in size of the nerve cells.10 ventricular
enlargement to be a more sensitive indicator of
cortical atrophy due to increasing age and
dementias.11 Studies show there was enlarger of the
lateral ventricles in epilepsy and also in depression.12
To understand these changes the knowledge of
normal morphometry and size of normal ventricular
system of brain is important.
Aims and objectives
1) The aim of the study to analyze the morphometric
measurements of ventricular systems of the brain in
different age group individuals of both genders.
2) To study the symmetry of lateral ventricle on
either side and to compare the result of this study
with previous study.
MATERIAL AND METHODS
This was the prospective study in which
Computerized Tomography images of total 358
(Males - 207 and Females - 151) in which 270 adult
individuals (Age Group 20-60 years) and 88 ageing
individuals (Age above 60 years) of either sex
attending the Department of Radiodiagnosis,
A.V.B.R.H., Jawaharlal Nehru medical college from
the year between January 2010 to august 2011. The
criteria for exclusion of individuals in this study
were:
1) Individuals below 20 years of age
2) Any history of local mass lesion in brain
3) Any history of cerebral infarction
4) Any history of hydrocephalus
5) Any history of alcoholism, drug abuse and trauma
or previous history of intracranial surgery
Computer tomography of these patients was
performed on “PHILIPS BRILLIANCE MULTI
SLICE (16 SLICE) MULTI DETECTOR SPIRAL
CT SCANNER” with a scan time of 1-10 sec and
slice thickness of 5 mm in the posterior cranial fossa
and 10 mm in above region. Study protocol was
submitted to the institutional ethical committee and
their permission was obtained. The patient was placed
on the Computerized Tomography table in supine
position and head was centered to the cris-cross point
of the light beam was made to coincide with the
orbito-meatal line. This position represented the zero
table position.13 The Computerized Tomography scan
images of the brain taken up to the highest level of
cranial vault and it was statistically analyzed.
The following measurements were made from the CT
images which obtained by the standard protocol made
by the radiological society. :
1. Measurement of the fourth ventricle
a). Vertical diameter - Greatest vertical distance
length (mm) of the fourth ventricle (from upper
margin of pons to lower limit of open part of medulla
oblongata). (Figure no. 4 and 5)
b). Transverse diameter - Greatest transverse
diameter measures in mm (maximum transverse
distance along the coronal plane). (Figure no.3)
2) Measurement of third ventricle (Figure no.4)
a) Greatest vertical diameter - height (mm) in
transverse plane in antero-posterior extent.
b) Greatest transverse diameter - transverse diameter
measures in (mm) maximum in coronal plane.
3) Measurement of lateral ventricle of right and left
side. (Figure no.5)
a) Greatest anterior-posterior extent measures in
(mm) for frontal horn of the lateral ventricle.
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Brij et al., Int J Med Res Health Sci. 2014;3(2): 381-387
b) Greatest anterior-posterior extent measures in mm
for frontal horn and including body of the lateral
ventricle.
RESULTS
Table no. 1 shows the measurements of height of
fourth ventricle. After analysis it was observed that
the height of the fourth ventricle was larger in males
(12.18 ± 1.54, 95% CI 11.97 - 12.39 mm) as
compared to females (12.13 ± 1.41, 95% CI 11.91 -
12.36 mm), which was statistically insignificant
(T=0.314 p= 0.753). Table no. 1 shows the
measurements of maximum width of fourth ventricle.
The width of the fourth ventricle was observed to be
greater in males (11.07 ± 1.54, 95% CI 10.85 - 11.28
mm) than in females (11.05 ± 1.31, 95% CI 10.84-
11.26 mm), which was also statistically insignificant
(T= 0.129 p=0.897).Table no. 2 shows the
measurements of length of third ventricle. The length
of the third ventricle was observed to be greater in
females (18.86 ± 8.36, 95% CI 17.52 –20.21 mm)
than in males (17.97 ± 2.76, 95% CI 17.59 -18.35
mm), which was statistically insignificant (T= -1.429
p= 0.154). Table no. 3 show the measurements taken
of the third ventricle. After analysis of the width of
the third ventricle it was observed to be greater in
males (3.47 ± 1.07, 95% CI 3.32 - 3.62 mm) than in
females (3.31 ± 0.94, 95% CI 3.16 - 3.46 mm) and
this difference was statistically insignificant (T=
1.470 p= 0.164).Table no. 4 shows various
measurements taken of the lateral ventricles. On
analyzing these it was observed that the antero-
posterior extent of the left frontal horn (males = 26.26
± 2.94, 95% CI 25.86 - 26.66 mm and females =
26.53 ± 3.38, 95% CI 25.99 - 27.08 mm) was greater
than that of the right ones (males = 25.00 ± 3.18, 95%
CI 24.57 - 25.44 mm and females = 25.34 ± 3.50,
95% CI 24.78 - 25.90 mm). Same thing also observed
in the antero-posterior extent of the left lateral
ventricular body including its frontal horn (males =
56.70 ± 6.61, 95% CI 55.79 - 57.61 mm and females
= 56.28 ± 7.59, 95% CI 55.06 - 57.50 mm) was
greater than the right one (males = 55.78 ± 6.15, 95%
CI 54.94 - 56.63 mm and females = 55.10 ± 6.99,
95% CI 53.97 - 56.22 mm).Table no. 5 shows the age
wise distribution of the length of right sided lateral
ventricle frontal horn with body, right sided lateral
ventricle frontal horn, width of the third ventricle and
width of the fourth ventricle. It was observed that as
the age advances dimensions of the ventricles also
enlarges and this difference was statistically
significant by ANOVA test for length of right Lateral
Ventricle (Frontal horn with body) f=26.77
p=0.000, length of right Lateral Ventricle (Frontal
horn) f=15.46 p=0.000, Width of third ventricle
f=3.89 p=0.021 and for the Width of fourth ventricle
value is f=0.49 p=0.614 (Not significant).
Table 1: Measurements of Fourth Ventricle (mm)
Height
width
Males (n=207)
Females (n=151)
Males (n=207)
Females (n=151)
Mean ± SD Units
12.18± 1.54
12.13± 1.41
11.07± 1.54
11.05 ± 1.31
95% CI (L)
11.97
11.91
10.85
10.84
95% CI (U)
12.39
12.36
11.28
11.26
T Value
0.314
0.129
P Value
0.753
0.897
<0.05 (Not significant)
Table 2: Measurements of Third Ventricle (mm)
Length
width
Males (n=207)
Females (n=151)
Males (n=207)
Females (n=151)
Mean ± SD
17.97± 2.76
18.86± 8.36
3.47± 1.07
3.31± 0.94
95% CI (L)
17.59
17.52
3.32
3.16
95% CI (U)
18.35
20.21
3.62
3.46
T Value
-1.429
1.470
P Value
0.154
0.164
<0.05 (Not significant)
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Brij et al., Int J Med Res Health Sci. 2014;3(2): 381-387
Table 3: Measurements of Lateral Ventricle (mm)
Fourth Ventricle
Frontal horn
Frontal horn + body
Males (n=207)
Females (n=151)
Males (n=207)
Females (n=151)
R
L
R
L
R
L
R
L
Mean ± SD
25.00±3.18
26.26±2.94
25.34±3.50
26.53±3.38
55.78± 6.15
56.70± 6.61
55.10± 6.99
56.28± 7.59
95% CI (L)
24.57
25.86
24.78
25.99
54.94
55.79
53.97
55.06
95% CI (U)
25.44
26.66
25.90
27.08
56.63
57.61
56.22
57.50
Table No. 4: Ventricular enlargement (age wisedistribution in mm).
Age
groups
(Yrs)
Length of Rt. Lat.
Ventricle (Frontal
horn with body)
Length of Rt. Lat.
Ventricle (Frontal
horn)
Width of 3rd
ventricle
Width of 4th
ventricle
Mean ± SD
Mean ± SD
Mean ± SD
Mean ± SD
20-40
52.23±4.80
23.93±2.34
3.22±0.76
10.93±1.46
41-60
55.80
6.18
25.44
3.20
3.33
0.90
11.09
1.38
>61
57.73
6.92
25.92
3.77
3.61
1.30
11.06
1.53
Fig 1: Maximum upper extent of the fourth ventricle
for vertical dimension
Fig 2: Maximum lower extent of the fourth ventricle
for vertical dimension
Fig 3: Maximum width of the fourth ventricle for
vertical dimension
Fig 4: a–b = maximum antero-posterior dimension
of third ventricle, c –d =maximum width of third
ventricle
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Brij et al., Int J Med Res Health Sci. 2014;3(2): 381-387
Fig 5: a–b = maximum antero-posterior dimension
of right frontal horn with body at the level of
interventricular foramina of the lateral ventricle, c –d
=maximum antero-posterior dimension of left frontal
horn with body at the level of interventricular
foramina of the lateral ventricle
DISCUSSION
The human nervous system is the most complex,
widely investigated with recent advance tools like CT
and MRI scan but yet poorly understood physical
system known to the mankind.14-18 many studies
reveals that brain regression involving cerebrum and
cerebellum usually begins at the age in the beginning
of seventh decade and thereafter accelerated as age
advances. Lateral ventricular contours are relatively
constant, except for the occipital horns.19 The
ventricular system can be better visualized by using
modern computerized x-ray tomography, which
allows easy and safe noninvasive study without
complications and it can be used as a screening
procedure for many pathological conditions.4, 20-23
Roberts et al revealed that the value in evaluating
dementia and its use in excluding brain diseases like
neoplasm’s, subdural hematomas, and
cerebrovascular disease that may mimic like
dementia.23 The ventricular size changes in the brain
encountered in routine clinical practices can mislead
to most of the physicians and surgeons to take proper
decision. However, there is likely to be an increasing
number of circumstances in which precise
measurements will be needed. Gawler et al13 (1976)
revealed that the greatest distance between the roof
and the floor of the fourth ventricle was less than 1.2
cms with a mean of 1.08 cms; however in the present
study this distance is significantly larger in males
(12.18 ± 1.54, 95% CI 11.91 - 12.39 mm) than in
females (12.13 ± 1.41, 95% CI 11.91 - 12.36 mm)
(Table no. 1). In the present study, the height of the
fourth ventricle was found to be greater than the
width in both genders. Width of the fourth ventricles
is more in males (11.07 ± 1.54, 95% CI 10.85 - 11.28
mm) than in females (11.05 ± 1.31, 95% CI 10.84-
11.26 mm) (Table no. 2).Brinkman et al 24 (1981),
Soininen et al 25 (1982), D'Souza e Dias Medora C.et
al 26 (2007) found that the maximum width of the
third ventricle had a mean of 0.46 cms, 0.59 cms,
0.92 ± 2.71 cms and 0.45 ± 0.29 cms respectively,
with higher values in males. In the present study this
measure was found to be significantly higher in males
(3.47 ± 1.07, 95% CI 3.32 - 3.62 mm) as compared to
females (3.31 ± 0.94, 95% CI 3.16 - 3.46 mm) (Table
no. 3).According to Glydensted 8(1977), Gomori et
al 27 (1984) Takeda and Matsuzawa 28 (1985),
Goldstein et al 29 (2001) and D'Souza e Dias Medora
C. et al 26 (2007) the left lateral ventricle was larger
than the right one and both were larger in males. In
present study, the anteroposterior extent of the left
frontal horns (males = 26.26 ± 2.94, 95% CI 25.86 -
26.66 mm and females = 26.53 ± 3.38, 95% CI 25.99
- 27.08 mm) was greater than that of the right ones
(males = 25.00 ± 3.18, 95% CI 24.57 - 25.44 mm and
females = 25.34 ± 3.50, 95% CI 24.78 - 25.90
mm).The antero-posterior extent of the left lateral
ventricular bodies including their frontal horns (males
= 56.70 ± 6.61, 95% CI 55.79 –57.61 mm and
females = 56.28 ± 7.59, 95% CI 55.06 –57.50 mm)
was greater than the right ones (males = 55.78 ± 6.15,
95% CI 54.94 –56.63 mm and females = 55.10 ±
6.99, 95% CI 53.97 –56.22 mm) (Table no. 5).
CONCLUSION
The structure of human brain is complicated and yet
not fully understood till date. As the human brain
ages, characteristic structural changes occur that can
be considered normal and are expected too. Advances
in sensitive imaging techniques like the
Computerized Tomography helps in dramatic
expansion of our understanding of the normal
structure of brain. The purpose of this study was to
examine the different dimensions of ventricular
system.
The present study has defined the morphometric
measurements of the lateral ventricles, third ventricle,
and fourth ventricle of the brain which has clinical
correlations in diagnosis and for further line of
treatment.
386
Brij et al., Int J Med Res Health Sci. 2014;3(2): 381-387
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