1
|
He Y, Tao Y, Tian J, Bao M, Zhang M, Huang Q, Li H, Chang X, Li K, Liu P, Guo L, Qin X, Huang C, Wu B. Unveiling the domino effect: a nine-year follow-up on pentalogy of central nervous system induced by a large unruptured cerebral arteriovenous malformation: a case report and literature review. Front Neurol 2024; 15:1365525. [PMID: 38846033 PMCID: PMC11153792 DOI: 10.3389/fneur.2024.1365525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background The disruption of intracranial fluid dynamics due to large unruptured cerebral arteriovenous malformation (AVM) commonly triggers a domino effect within the central nervous system. This phenomenon is frequently overlooked in prior clinic and may lead to catastrophic misdiagnoses. Our team has documented the world's first case of so-called AVM Pentalogy (AVMP) induced by a AVM. Clinical presentation and result A 30-year-old female was first seen 9 years ago with an occasional fainting, at which time a huge unruptured AVM was discovered. Subsequently, due to progressive symptoms, she sought consultations from several prestigious neurosurgical departments in China, where all consulting neurosurgeons opted for conservation treatment due to perceived surgical risks. During the follow-up period, the patient gradually presented with hydrocephalus, empty sella, secondary Chiari malformation, syringomyelia, and scoliosis (we called as AVMP). When treated in our department, she already displayed numerous symptoms, including severe intracranial hypertension. Our team deduced that the hydrocephalus was the primary driver of her AVMP symptoms, representing the most favorable risk profile for intervention. As expected, a ventriculoperitoneal shunt successfully mitigated all symptoms of AVMP at 21-months post-surgical review. Conclusion During the monitoring of unruptured AVM, it is crucial to remain vigilant for the development or progression of AVMP. When any component of AVMP is identified, thorough etiological studies and analysis of cascade reactions are imperative to avert misdiagnosis. When direct AVM intervention is not viable, strategically addressing hydrocephalus as part of the AVMP may serve as the critical therapeutic focus.
Collapse
Affiliation(s)
- Yunsen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jing Tian
- Department of Neurosurgery, The People’s Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Mingbin Bao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Mengjun Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinjiang Huang
- Department of Neurosurgery, Wenjiang District People’s Hospital of Chengdu, Chengdu, China
| | - Hongliang Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Xinxin Chang
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Kun Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Ping Liu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lili Guo
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaohong Qin
- Department of Neurosurgery, The People’s Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Caiquan Huang
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Omar AT, Sandoval MAS, Pascual JLR, Khu KJO. Management of Hydrocephalus in Paget's Disease of Bone: Systematic Review and Illustrative Case. World Neurosurg 2019; 135:e640-e649. [PMID: 31881339 DOI: 10.1016/j.wneu.2019.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Paget's disease of the bone (PDB) is a focal bone disorder characterized by excessive resorption and deposition of pathologic bone. It can involve the skull and cause neurologic dysfunction. Hydrocephalus occurring as a complication has also been reported. However, owing to its rarity, the optimal treatment has not yet been determined. METHODS We report the case of a 60-year-old woman with a diagnosis of PDB who had presented with symptomatic hydrocephalus and was successfully treated with ventriculoperitoneal shunt insertion. We also performed a systematic review of the Scopus and PubMed databases for case reports and series documenting patients with PDB complicated by hydrocephalus and discussed the clinical features and therapeutic strategies used. RESULTS We found 28 cases of PDB complicated by hydrocephalus in reported studies, including the present case. The median age was 67 years (range, 48-85 years; interquartile range, 7 years), with a female sex predilection. The most common neurologic manifestations were cognitive impairment, gait unsteadiness, urinary incontinence, hearing loss, and headache. Surgery had been performed in 73% of the 28 cases. The most common operation was insertion of a ventriculoperitoneal shunt (63.2%). Cerebrospinal fluid diversion resulted in significant or complete neurologic recovery in 78.9% of the 28 patients. Posterior fossa decompression was performed in 15.8% of operative cases but did not significantly alter the clinical course. CONCLUSION Patients with hydrocephalus occurring as a complication of PDB will most commonly present with cognitive impairment, gait unsteadiness, and urinary incontinence. Surgery plays an important role in the treatment, with CSF diversion procedures resulting in significant neurologic recovery in most cases.
Collapse
Affiliation(s)
- Abdelsimar T Omar
- Section of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mark Anthony S Sandoval
- Department of Physiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose Leonard R Pascual
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Kathleen Joy O Khu
- Section of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| |
Collapse
|
3
|
De Maria L, Brinjikji W, Lanzino G. Unruptured brain arteriovenous malformations and hydrocephalus: Case series and review of the literature. J Clin Neurosci 2019; 64:116-121. [PMID: 30948310 DOI: 10.1016/j.jocn.2019.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Hydrocephalus is an uncommon presentation of unruptured brain arteriovenous malformations (AVMs). The goal of this case series and literature review is to present possible pathological mechanisms, management strategies and outcomes in patients with hydrocephalus due to unruptured AVMs. METHODS Three consecutive patients with hydrocephalus caused by unruptured AVMs as well as all cases previously reported in the literature were retrospectively reviewed to determine clinical symptoms, AVM location, nidus size, venous drainage, mechanism of hydrocephalus, level/cause of obstruction, and degree of hydrocephalus. Management of hydrocephalus, AVM treatment, and follow-up length were evaluated. RESULTS Of 350 patients unruptured AVMs, 3 presented with hydrocephalus (0.8%). In the literature review we found an additional 22 patients for a total of 25 cases. Eighteen patients had mechanical obstruction by the draining vein or the AVM nidus, usually at the level of the aqueduct (52%). Impaired cerebrospinal fluid resorption secondary to venous congestion led to hydrocephalus in 7 patients. Ten patients were treated for both the AVM and hydrocephalus, 13 patients underwent treatment of either hydrocephalus, or the AVM alone. Treatment of hydrocephalus, with or without associated treatment of the brain AVM, resulted in improvement of symptoms in 92% of patients. No rupture of the AVM was reported at follow-up. CONCLUSIONS The most common cause of hydrocephalus in unruptured brain AVMs is mechanical obstruction by the draining vein if it is located in a strategic position. Treatment of hydrocephalus alone or with associated treatment of the AVM is safe and effective.
Collapse
|
4
|
Respiration: A New Mechanism for CSF Circulation? J Neurosci 2018; 37:7076-7078. [PMID: 28747391 DOI: 10.1523/jneurosci.1155-17.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 11/21/2022] Open
|
5
|
Diren F, Sencer S, Hakan T. Case Report of an Obstructive Hydrocephalus Caused by an Unruptured Mesencephalic Arteriovenous Malformation in a Boy and a Review of Literature. Open Neuroimag J 2018. [PMID: 29541280 PMCID: PMC5842379 DOI: 10.2174/1874440001812010010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Arteriovenous malformation (AVM) is the most common form of intracranial vascular malformations in adults. Intracranial pediatric AVMs are rare. AVM located in the vicinity of the brain stem in children are even more rare. Case report This study reports a rare case of acute obstructive hydrocephalus following aqueductal stenosis caused by an unruptured grade IV perimesencephalic arteriovenous malformation. An 11-year-old boy admitted to the hospital with progressive headache, nausea and vomiting throughout a month. A Computerized Tomography (CT) showed an obstructive hydrocephaly. A Magnetic Resonance (MR) imaging revealed a mesencephalic AVM compressing the aqueduct. The patient deteriorated in hours and an emergency ventriculoperitoneal shunting was performed. He did well in the early postoperative period. AVM examined with Digital Subtraction Angiography (DSA) in detail for maintaining the definitive treatment by means of endovascular embolization, microsurgery and stereotactic radiosurgery; but the patient was lost to follow up. Conclusion A Pubmed search revealed 34 cases of hydrocephalus caused by an unruptured AVM in the literature, and only four cases were less than 18 years old with unruptured AVM locating in brain stem or posterior fossa. Although focal neurologic deficit, seizure and headache are the most common symptoms, acute neurologic deterioration due to hydrocephalus may be the presenting symptom in these cases. The decrease in intracranial pressure by changing the flow of cerebrospinal fluid (CSF) via an emergency ventriculoperitoneal (VP) shunting or Endoscopic Third Ventriculostomy (ETV) can be a lifesaving procedure that gives a chance for further treatment modalities.
Collapse
Affiliation(s)
- Furkan Diren
- International Kolon Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Serra Sencer
- İstanbul University, İstanbul Medical School, Neuroradiology Department, İstanbul, Turkey
| | - Tayfun Hakan
- International Kolon Hospital, Neurosurgery Clinic, İstanbul, Turkey.,Okan University, Vocational School of Health Services, İstanbul, Turkey
| |
Collapse
|
6
|
Krishnamurthy S, Li J. New concepts in the pathogenesis of hydrocephalus. Transl Pediatr 2014; 3:185-94. [PMID: 26835336 PMCID: PMC4729848 DOI: 10.3978/j.issn.2224-4336.2014.07.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/20/2014] [Indexed: 12/28/2022] Open
Abstract
Hydrocephalus is a central nervous system disorder characterized by excessive accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. Cognitive and physical handicap can occur as a result of hydrocephalus. The disorder can present at any age as a result of a wide variety of different diseases. The pathophysiology of hydrocephalus is unclear. While circulation theory is widely accepted as a hypothesis for the development of hydrocephalus, there is a lack of adequate proof in clinical situations and in experimental settings. However, there is growing evidence that osmotic gradients are responsible for the water content of the ventricles of the brain, similar to their presence in other water permeable organs in the body. Therefore, brain disorders that results in excess macromolecules in the ventricular CSF will change the osmotic gradient and result in hydrocephalus. This review encompasses several key findings that have been noted to be important in the genesis of hydrocephalus, including but not limited to the drainage of CSF through the olfactory pathways and cervical lymphatics, the paravascular pathways and the role of venous system. We propose that as osmotic gradients play an important role in the water transport into the ventricles, the transport of osmotically active macromolecules play a critical role in the genesis of hydrocephalus. Therefore, we can view hydrocephalus as a disorder of macromolecular clearance, rather than circulation. Current evidence points to a paravascular and/or lymphatic clearance of these macromolecules out of the ventricles and the brain into the venous system. There is substantial evidence to support this theory, and further studies may help solidify the merit of this hypothesis.
Collapse
Affiliation(s)
- Satish Krishnamurthy
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Jie Li
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| |
Collapse
|
7
|
Rodríguez Rodríguez R, Molet Teixido J. Letter to the Editor of Acta Neurochirurgica: Obstructive hydrocephalus caused by unruptured arteriovenous malformation treated with endoscopic third ventriculostomy. Acta Neurochir (Wien) 2013; 155:901-2. [PMID: 23474733 DOI: 10.1007/s00701-013-1673-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/24/2013] [Indexed: 11/24/2022]
|
8
|
Naydenov E, Bussarsky V, Minkin K, Bussarsky A, Nachev S, Traykov L. Normal pressure hydrocephalus as an unusual presentation of supratentorial extraventricular space-occupying processes: report on two cases. Case Rep Oncol 2012; 5:143-7. [PMID: 22666203 PMCID: PMC3364074 DOI: 10.1159/000336162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Normal pressure hydrocephalus (NPH) is a clinical and radiographic syndrome characterized by ventriculomegaly, abnormal gait, urinary incontinence, and dementia. The condition may occur due to a variety of secondary causes but may be idiopathic in approximately 50% of patients. Secondary causes may include head injury, subarachnoid hemorrhage, meningitis, and central nervous system tumor. Here, we describe two extremely rare cases of supratentorial extraventricular space-occupying processes: meningioma and glioblastoma multiforme, which initially presented with NPH.
Collapse
Affiliation(s)
- E Naydenov
- Department of Neurosurgery, University Hospital 'St. Ivan Rilski', Sofia, Bulgaria
| | | | | | | | | | | |
Collapse
|
9
|
Ebinu JO, Matouk CC, Wallace MC, Terbrugge KG, Krings T. Hydrocephalus secondary to hydrodynamic disequilibrium in an adult patient with a choroidal-type arteriovenous malformation. Interv Neuroradiol 2011; 17:212-6. [PMID: 21696661 DOI: 10.1177/159101991101700212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 02/01/2011] [Indexed: 11/15/2022] Open
Abstract
We describe an adult patient with an unruptured choroidal-type arteriovenous malformation (AVM) associated with progressive hydrocephalus. There was no evidence of mechanical obstruction of the ventricular system by the AVM nidus itself or a draining vein. However significant reflux into periventricular and transmedullary veins was demonstrated. Following partial targeted embolization of the AVM, no further reflux was observed, the patient's clinical deficits resolved, and the hydrocephalus improved. We suggest a hydrodynamic disorder as a potential pathomechanism of hydrocephalus in this adult patient with an unruptured AVM.
Collapse
Affiliation(s)
- J O Ebinu
- Departments of Surgery and Medical Imaging, The University of Toronto Brain Vascular Malformation Study Group, The Toronto Hospital, Western Division, ON, Canada
| | | | | | | | | |
Collapse
|
10
|
Geibprasert S, Pereira V, Krings T, Jiarakongmun P, Lasjaunias P, Pongpech S. Hydrocephalus in unruptured brain arteriovenous malformations: pathomechanical considerations, therapeutic implications, and clinical course. J Neurosurg 2009; 110:500-7. [PMID: 18950262 DOI: 10.3171/2008.7.jns0815] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECT The goal in this study was to present possible pathological mechanisms, clinical and imaging findings, and to describe the management and outcome in patients with hydrocephalus due to unruptured pial brain arteriovenous malformations (AVMs). METHODS Medical records and imaging findings in 8 consecutive patients with hydrocephalus caused by AVMs and treated between June 2000 and September 2007 were retrospectively reviewed to determine clinical symptoms, AVM location, venous drainage, level/cause of obstruction, and degree of hydrocephalus. Management of hydrocephalus, AVM treatment, complications, and follow-up results were evaluated. RESULTS Headaches were the most common clinical symptom (7 of 8 patients). Deep venous drainage was identified in all patients. Mechanical obstruction by the draining vein or the AVM nidus was seen in 6 patients, in whom obstruction occurred at the interventricular foramen (2 patients) or the aqueduct (4 patients). Hydrodynamic disorders following venous outflow obstruction and venous congestion of the posterior fossa led to hydrocephalus in the remaining 2 patients. Ventriculoperitoneal (VP) shunts were placed in 6 of 8 patients with a moderate to severe degree of hydrocephalus. Regression of hydrocephalus was noted in 4 patients, whereas in 2 the imaging findings were stable, 1 of whom had decreased hydrocephalus only after AVM size reduction. In 2 patients with mild hydrocephalus who were not treated with shunt insertion, 1 improved and 1 was clinically stable after AVM treatment. CONCLUSIONS The most common cause of hydrocephalus in unruptured brain AVMs is mechanical obstruction by the draining vein if it is located in a strategic position. Management should be aimed at treatment of the AVM; however, VP shunts may be necessary in acute and severe cases of hydrocephalus.
Collapse
Affiliation(s)
- Sasikhan Geibprasert
- Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | |
Collapse
|
11
|
Moiyadi AV, Praharaj SS, Pillai VS, Chandramouli BA. Hydrocephalus in Paget's disease. Acta Neurochir (Wien) 2006; 148:1297-300; discussion 1300. [PMID: 17086474 DOI: 10.1007/s00701-006-1048-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 09/15/2006] [Indexed: 10/23/2022]
Abstract
Neurological manifestations in Paget's disease are rare. Hydrocephalus is infrequent, its etiology in Paget's disease being multi-factorial. Surgical and anesthetic procedures may be challenging, requiring special precautions. We describe one such case and discuss these peculiarities. An elderly lady, diagnosed to have Paget's disease presented with features of recent onset dementia, gait disturbances with urinary incontinence. Hydrocephalus secondary to posterior fossa crowding was present. A ventriculo-peritoneal shunt was inserted. Endotracheal intubation proved to be difficult. Modification of the surgical technique was required to ensure a safe procedure. She improved immediately following CSF diversion. Timely CSF diversion yields good results. Certain precautions during anesthesia and surgery can ensure a safe and uneventful peri-operative period.
Collapse
Affiliation(s)
- A V Moiyadi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | | | | | | |
Collapse
|
12
|
Hamlat A, Adn M, Sid-ahmed S, Askar B, Pasqualini E. Theoretical considerations on the pathophysiology of normal pressure hydrocephalus (NPH) and NPH-related dementia. Med Hypotheses 2006; 67:115-23. [PMID: 16530979 DOI: 10.1016/j.mehy.2006.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 01/18/2006] [Indexed: 10/24/2022]
Abstract
Normal pressure hydrocephalus (NPH) is considered to be an example of reversible dementia although clinical improvement after shunting varies from subject to subject, and recent studies have pointed to a possible link with other dementia. The authors consider that the craniospinal compartment is a partially closed sphere with control device systems represented by the spinal axis and the sagittal sinus-arachnoid villi complex which interact with each other in the clinical patient setting. We hypothesise that changing spinal compliance by altering the flow process and CSF dynamics lead to hydrocephalus. Therefore four NPH types have been distinguished according to the alterations in spinal compliance, decrease in CSF absorption at the sagittal sinus or both occurrences. The authors consider that NPH and NPH-related diseases (NPH-RD) are initiated by the same common final pathway and demonstrate that NPH could represent an initial stage of NPH-RD. Progression of clinical signs can be explained as damage to the cerebral tissue by both intermittent increased intracranial pressure and pulse pressure waves leading to periventricular ischaemia. In addition, they believe that both volume equilibrium and spinal compliance are restored in patients who improve after CSF shunt, whereas in patients whose condition does not improve, only volume equilibrium is restored and not spinal compliance, which was the underlying cause of hydrocephalus in such cases. They therefore wonder whether cervical decompression should not be indicated in patients who show no improvement. Although attractive, this analysis warrants confirmation from clinical, radiological, and hydrodynamic studies.
Collapse
Affiliation(s)
- Abderrahmane Hamlat
- Department of Neurosurgery, Service de neurochirurgie, CHRU Pontchaillou, Rue Henri Le Guilloux, 35000 Rennes Cedex 2, France.
| | | | | | | | | |
Collapse
|
13
|
Hamlat A, Pasqualini E, Askar B. Hypothesis about the physiopathology of acute deterioration and sudden death caused by colloid cysts of the third ventricle. Med Hypotheses 2004; 63:1014-7. [PMID: 15504569 DOI: 10.1016/j.mehy.2004.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Accepted: 04/27/2004] [Indexed: 11/18/2022]
Abstract
In this paper, the authors review the mechanisms of acute deterioration and sudden death caused by colloid cysts (CCs). These dreaded events are widely recognized complications of CC, however the mechanism(s) in cause has been subject to controversy. Increased intracranial pressure (ICP) is a common event associated with many cerebral disorders, including colloid cysts, though compensatory mechanisms may allow ICP to remain at normal levels. However, a compensated system might decompensate for many factors such as intracranial haemorrhage, acute hydrocephalus, brain oedema, or an increase in sagittal sinus pressure (SSP). The sagittal sinus in adults with brain tumours appears to respond unpredictably when ICP increases and in some patients, when ICP increased the SSP increased too due to the fact that their sinuses collapse. We therefore speculate that the mechanism of acute deterioration and sudden death is a multifactorial and dynamic process, in which the increase in sagittal sinus pressure would appear to be an important element. It seems possible that acute deterioration is initiated by an increase in sagittal sinus pressure, which provokes acute brain swelling, with a series of often-irreversible events, leading to sudden death. Since the majority of cases of acute deterioration and death are due to CCs of the third ventricle, the authors suggest that surgical resection should be carried out on diagnosed CCs measuring over 1 cm, because sudden death has not been reported as having been caused by colloid cysts measuring less than this dimension.
Collapse
Affiliation(s)
- Abderrahmane Hamlat
- Department of Neurosurgery, CHRU Pontchaillou, Rue Henry Le Guilloux, 35000 Rennes, Cedex 2, France.
| | | | | |
Collapse
|