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A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.<\/jats:p>","DOI":"10.1136\/bcr-2020-238893","type":"journal-article","created":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T16:55:13Z","timestamp":1612198513000},"page":"e238893","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Progressive midbrain clefts after head trauma and decompressive surgery: a report of two patients"],"prefix":"10.1136","volume":"14","author":[{"given":"Padma John","family":"Pramila","sequence":"first","affiliation":[{"name":"Neurology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavithra","family":"Mannam","sequence":"additional","affiliation":[{"name":"Radiology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari George","family":"Chacko","sequence":"additional","affiliation":[{"name":"Neurosurgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1124-8119","authenticated-orcid":false,"given":"Rohit Ninan","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Neurology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,1]]},"reference":[{"key":"2025082708275780000_14.2.e238893.1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1988.00520260113030"},{"key":"2025082708275780000_14.2.e238893.2","doi-asserted-by":"crossref","unstructured":"Sherrod BA , Yoon NK , Anzai Y . 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