Nonprogressive congenital unilateral ventriculomegaly

Case Report: Occlusion of the foramen of Monro treated with endoscopic septostomy and foraminotomy in a preterm neonate

Background

Hydrocephalus is a brain abnormality frequently encountered in neonates. There are several known etiologies of hydrocephalus, which can be classified as either congenital or acquired. Occlusion of the foramen of Monro (FOM) is a cause of hydrocephalus and can be either congenital or secondary to various disorders. Idiopathic obstruction of the FOM presenting as prenatal ventriculomegaly is extremely rare but has been reported.

Case presentation

We present the case of a preterm newborn with severe bilateral hydrocephalus due to FOM occlusion in the prenatal period. Although the neonate had normal head circumference and no clinical symptoms after birth, brain sonography revealed progressive ventriculomegaly. Further image revealed bilateral ventriculomegaly with normal-sized third and fourth ventricles. We suspected a complete obstruction of the right and a partial obstruction of the left of the FOM. The neonate underwent endoscopic septostomy and foraminotomy, resulting in improvement.

Conclusion

We report a case of preterm FOM occlusion in the youngest and smallest neonate to date. Endoscopic septostomy and foraminotomy were performed in order to avoid ventriculoperitoneal shunt-related complications, highlighting the viability of endoscopic procedures which should be the primary treatment in preterm neonates with FOM occlusion.

Congenital obstruction of foramen of Monro: report of 10 patients and literature review

INTRODUCTION

A wide spectrum of etiologies can obstruct foramen of Monro (FOM) and result in hydrocephalus. Congenital occlusion of FOM is a rare entity which may present either in childhood or in adulthood.

METHODS

Between 2007 and 2016, we screened all pediatric patients with hydrocephalus of either one or both lateral ventricles. Congenital occlusion of FOM was confirmed in the absence of masses occupying the FOM, prenatal or postnatal central nervous system (CNS) infections, intraventricular hemorrhage, previous cerebral intervention, or associated CNS anomalies affecting the flow of cerebrospinal fluid (CSF). We have performed a comprehensive literature review of the previously reported cases and provided a tentative embryological pathogenesis of FOM occlusion.

RESULTS

We introduce 10 new cases of congenital FOM obstruction. The mean age of the patients was 6.65 ± 10.51 months. Two patients underwent ventriculo-peritoneal (VP) shunting as the primary intervention, while endoscopic septostomy was performed in the others. The mean follow-up was 3.05 ± 2.16 years (1-8 years). Although the hydrocephalus was controlled, all patients remained hemiparetic with some degree of developmental and cognitive impairments. Previously, 38 similar cases were reported: 10 of them (26.3%) were adults. Overall, VP shunting was the treatment of choice in 44.7% of patients. While most adults fully recovered, 7.2% of pediatrics remained hemiparetic and 10.7% of them had cognitive and developmental delay.

CONCLUSION

Ten cases of congenital obstruction of the foramen of Monro have been managed through a period of 9-year study. Details of these patients in addition to 38 previously reported cases are presented in this study.

Cognitive impairment in a young marmoset reveals lateral ventriculomegaly and a mild hippocampal atrophy: a case report

The number of studies that use the common marmoset (Callithrix jacchus) in various fields of neurosciences is increasing dramatically. In general, animals enter the study when their health status is considered satisfactory on the basis of classical clinical investigations. In behavioral studies, variations of score between individuals are frequently observed, some of them being considered as poor performers or outliers. Experimenters rarely consider the fact that it could be related to some brain anomaly. This raises the important issue of the reliability of such classical behavioral approaches without using complementary imaging, especially in animals lacking striking external clinical signs. Here we report the case of a young marmoset which presented a set of cognitive impairments in two different tasks compared to other age-matched animals. Brain imaging revealed a patent right lateral ventricular enlargement with a mild hippocampal atrophy. This abnormality could explain the cognitive impairments of this animal. Such a case points to the importance of complementing behavioral studies by imaging explorations to avoid experimental bias.

Perinatal and neurodevelopmental outcome with isolated fetal ventriculomegaly: A systematic review

OBJECTIVE

To establish the perinatal and neurodevelopmental outcomes of fetuses diagnosed with isolated ventriculomegaly (IVM).

METHODS

A systematic review of cohort, case/control studies, case series and case reports of IVM (unilateral or bilateral enlargement of the lateral ventricle, >or=10 mm, with no additional diagnosis at the time of the initial ultrasound), identified by searching, without language restrictions, The Cochrane Library, MEDLINE and Embase databases in June 2004.

RESULTS

No cohort study was retrieved but 577 cases were identified in one case/control study and 29 case series/case reports. Of 207 cases with follow-up and known gestational age at diagnosis, normal developmental outcomes were found in 82%, mild impairments in 9% and moderate/severe impairments in 10%. Prenatal diagnosis could possibly have reduced the risk of moderate/severe impairments to 7%. In 137 cases followed to at least 20 months of age, 79% had normal neurodevelopment, 10% were mildly delayed and 11% had moderate/severe developmental delays.

CONCLUSIONS

Outcome was favorable in 85% of IVM cases, decreasing to 79% when cases were followed to at least 20 months of age. We recommend prospective cohort studies with new diagnostic modalities to better identify the underlying conditions relating to moderate/severe impairments in the remaining cases.