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Di Salle G, Migaleddu G, Canovetti S, Liberti G, Perrini P, Cosottini M. Rare Complications of CSF Diversion: Paradoxical Neuroimaging Findings in a Double, Chiasmic Case Report. Diagnostics (Basel) 2024; 14:1141. [PMID: 38893666 PMCID: PMC11172121 DOI: 10.3390/diagnostics14111141] [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: 04/22/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Two patients with CSF shunting systems exhibited symptoms of altered intracranial pressure. Initial neuroimaging led to misinterpretation, but integrating clinical history and follow-up imaging revealed the true diagnosis. In the first case, reduced ventricular size was mistaken for CSF overdrainage, while the actual problem was increased intracranial pressure, as seen in slit ventricle syndrome. In the second case, symptoms attributed to intracranial hypertension were due to CSF overdrainage causing tonsillar displacement and hydrocephalus. Adjusting the spinoperitoneal shunt pressure resolved symptoms and imaging abnormalities. These cases highlight the necessity of correlating clinical presentation with a deep understanding of CSF dynamics in shunt assessments.
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Affiliation(s)
- Gianfranco Di Salle
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy;
| | | | - Silvia Canovetti
- Neuroradiology Unit, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy;
| | - Gaetano Liberti
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
| | - Paolo Perrini
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Mirco Cosottini
- Neuroradiology Unit, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Azolai L, Constantini S, Constantini L, Roth J. Positional shunt assist for slit ventricle syndrome. Childs Nerv Syst 2024; 40:109-114. [PMID: 37695368 DOI: 10.1007/s00381-023-06145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Hydrocephalus is one of the most common pathologies in pediatric neurosurgery. One of the causes of recurring events of headaches among shunted children is "slit ventricle syndrome" (SVS). Several potential treatments have been proposed, yet SVS often represents a treatment challenge. The goal of the current series is to present our experience with adding a positional shunt-assist (SA) (Miethke, Aesculap) for the treatment of SVS. METHODS Clinical data was retrospectively collected from all consecutive children with SVS that were treated with SA (Miethke, Aesculap) at our center. Surgical and clinical outcomes as expressed by hospital visits, or need for additional surgery, were evaluated. RESULTS Nine cases were included. Hydrocephalus etiology included IVH (6), postinfectious (1), and congenital syndromes (2). Average age at first shunt was 4 months. Primary shunt type was differential-pressure-valve in all. Average age at SVS onset was 4 years. Average age at SA placement was 5.5 years. There were no perioperative complications besides a single stich abscess. A 6-month follow-up period after SA was compared to a 6-month period prior to the SA: average hospital visits decreased from 2.4 to 0.6 per patient (p < 0.0002). 4/9 patients needed an LP or shunt revision before the SA surgery, while no procedure was indicated during the immediate 6-month follow-up. At the last follow-up, there was a significant reduction in the rate of ER visits compared to prior to surgery; however, the number of neurosurgical procedures did not significantly differ. CONCLUSION Using a SA for SVS was associated with a short-term improvement of symptoms in the majority of cases, reduction in hospital visits, and reduced need for SVS-related procedures.
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Affiliation(s)
- Lee Azolai
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Lahav Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
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Xu H, Dugué GP, Cantaut-Belarif Y, Lejeune FX, Gupta S, Wyart C, Lehtinen MK. SCO-spondin knockout mice exhibit small brain ventricles and mild spine deformation. Fluids Barriers CNS 2023; 20:89. [PMID: 38049798 PMCID: PMC10696872 DOI: 10.1186/s12987-023-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023] Open
Abstract
Reissner's fiber (RF) is an extracellular polymer comprising the large monomeric protein SCO-spondin (SSPO) secreted by the subcommissural organ (SCO) that extends through cerebrospinal fluid (CSF)-filled ventricles into the central canal of the spinal cord. In zebrafish, RF and CSF-contacting neurons (CSF-cNs) form an axial sensory system that detects spinal curvature, instructs morphogenesis of the body axis, and enables proper alignment of the spine. In mammalian models, RF has been implicated in CSF circulation. However, challenges in manipulating Sspo, an exceptionally large gene of 15,719 nucleotides, with traditional approaches has limited progress. Here, we generated a Sspo knockout mouse model using CRISPR/Cas9-mediated genome-editing. Sspo knockout mice lacked RF-positive material in the SCO and fibrillar condensates in the brain ventricles. Remarkably, Sspo knockout brain ventricle sizes were reduced compared to littermate controls. Minor defects in thoracic spine curvature were detected in Sspo knockouts, which did not alter basic motor behaviors tested. Altogether, our work in mouse demonstrates that SSPO and RF regulate ventricle size during development but only moderately impact spine geometry.
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Affiliation(s)
- Huixin Xu
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Guillaume P Dugué
- Neurophysiology of Brain Circuits, Institut de Biologie de l'Ecole Normale Supérieure (IBENS), Ecole Normale Supérieure, CNRS, INSERM, Université PSL, 75005, Paris, France
| | - Yasmine Cantaut-Belarif
- Sorbonne Université, Paris Brain Institute (Institut du Cerveau, ICM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1127, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche 7225, Assistance Publique-Hôpitaux de Paris (APHP), Campus Hospitalier Pitié-Salpêtrière, 47, bld Hospital, 75013, Paris, France
| | - François-Xavier Lejeune
- Sorbonne Université, Paris Brain Institute (Institut du Cerveau, ICM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1127, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche 7225, Assistance Publique-Hôpitaux de Paris (APHP), Campus Hospitalier Pitié-Salpêtrière, 47, bld Hospital, 75013, Paris, France
| | - Suhasini Gupta
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Claire Wyart
- Sorbonne Université, Paris Brain Institute (Institut du Cerveau, ICM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1127, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche 7225, Assistance Publique-Hôpitaux de Paris (APHP), Campus Hospitalier Pitié-Salpêtrière, 47, bld Hospital, 75013, Paris, France.
| | - Maria K Lehtinen
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
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Frontera JA, Fang T, Grayson K, Lalchan R, Dickstein L, Hussain MS, Kahn DE, Lord AS, Mazzuchin D, Melmed KR, Rutledge C, Zhou T, Lewis A. Poor Accuracy of Manually Derived Head Computed Tomography Parameters in Predicting Intracranial Hypertension After Nontraumatic Intracranial Hemorrhage. Neurocrit Care 2023; 39:677-689. [PMID: 36577900 DOI: 10.1007/s12028-022-01662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The utility of head computed tomography (CT) in predicting elevated intracranial pressure (ICP) is known to be limited in traumatic brain injury; however, few data exist in patients with spontaneous intracranial hemorrhage. METHODS We conducted a retrospective review of prospectively collected data in patients with nontraumatic intracranial hemorrhage (subarachnoid hemorrhage [SAH] or intraparenchymal hemorrhage [IPH]) who underwent external ventricular drain (EVD) placement. Head CT scans performed immediately prior to EVD placement were quantitatively reviewed for features suggestive of elevated ICP, including temporal horn diameter, bicaudate index, basal cistern effacement, midline shift, and global cerebral edema. The modified Fisher score (mFS), intraventricular hemorrhage score, and IPH volume were also measured, as applicable. We calculated the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these radiographic features for the coprimary outcomes of elevated ICP (> 20 mm Hg) at the time of EVD placement and at any time during the hospital stay. Multivariable backward stepwise logistic regression analysis was performed to identify significant radiographic factors associated with elevated ICP. RESULTS Of 608 patients with intracranial hemorrhages enrolled during the study time frame, 243 (40%) received an EVD and 165 (n = 107 SAH, n = 58 IPH) had a preplacement head CT scan available for rating. Elevated opening pressure and elevated ICP during hospitalization were recorded in 48 of 152 (29%) and 103 of 165 (62%), respectively. The presence of ≥ 1 radiographic feature had only 32% accuracy for identifying elevated opening pressure (PPV 30%, NPV 58%, area under the curve [AUC] 0.537, 95% asymptotic confidence interval [CI] 0.436-0.637, P = 0.466) and 59% accuracy for predicting elevated ICP during hospitalization (PPV 63%, NPV 40%, AUC 0.514, 95% asymptotic CI 0.391-0.638, P = 0.820). There was no significant association between the number of radiographic features and ICP elevation. Head CT scans without any features suggestive of elevated ICP occurred in 25 of 165 (15%) patients. However, 10 of 25 (40%) of these patients had elevated opening pressure, and 15 of 25 (60%) had elevated ICP during their hospital stay. In multivariable models, mFS (adjusted odds ratio [aOR] 1.36, 95% CI 1.10-1.68) and global cerebral edema (aOR 2.93, 95% CI 1.27-6.75) were significantly associated with elevated ICP; however, their accuracies were only 69% and 60%, respectively. All other individual radiographic features had accuracies between 38 and 58% for identifying intracranial hypertension. CONCLUSIONS More than 50% of patients with spontaneous intracranial hemorrhage without radiographic features suggestive of elevated ICP actually had ICP > 20 mm Hg during EVD placement or their hospital stay. Morphological head CT findings were only 32% and 59% accurate in identifying elevated opening pressure and ICP elevation during hospitalization, respectively.
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Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA.
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
- Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Taolin Fang
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Kammi Grayson
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Rebecca Lalchan
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Leah Dickstein
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - M Shazam Hussain
- Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D Ethan Kahn
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Aaron S Lord
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Daniel Mazzuchin
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Kara R Melmed
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Caleb Rutledge
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Ting Zhou
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
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Kehoe L, Caird J, Crimmins D. Effectiveness of subtemporal decompression for the management of slit ventricle syndrome. Br J Neurosurg 2023:1-7. [PMID: 38014429 DOI: 10.1080/02688697.2023.2282076] [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: 08/23/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To assess the effectiveness of subtemporal decompression in the management of slit ventricle syndrome. METHODS We conducted a retrospective review of all patients with slit ventricle syndrome (SVS) who underwent subtemporal decompression (STD) at our centre between 2010 and 2021. Cases were identified using the hospital database. Medical records for each patient were reviewed, including operative and radiological reports. RESULTS Fifteen patients underwent STD for the management of SVS. Median age at time of STD was 9.18 years. Aetiology of hydrocephalus consisted of spinal dysraphism (5), idiopathic (4), post-infectious (1), post-haemorrhagic (3), secondary to tumour (1), and craniofacial anomalies (1). Median age at first shunt insertion was 3.4 months. Median pre-operative period assessed, from initial shunt insertion to STD, was 4.54 (interquartile range [IQR] 3.12-10.47) years. Twelve patients underwent ≥1 shunt revision prior to STD. All patients had a diagnosis of SVS at time of STD. Presenting symptoms, for the admission in which STD was performed, included nausea (9), vomiting (8), lethargy (8), headache (12), irritability (5), and visual disturbances (6). One third underwent shunt revision at the time of STD. Two patients developed post-operative complications requiring further surgery (meningitis requiring shunt revision: 1; wound debridement: 1). Three patients developed uncomplicated post-operative pyrexia, which was managed with antibiotics. Median duration of post-operative follow-up was 5.4 (IQR 1.73-8.54) years. Eleven patients underwent ≥1 shunt related procedure following STD. Wilcoxon signed-rank test demonstrated a significant difference in number of shunt related procedures before (median = 5, IQR 1-8) and after (median = 3, IQR 0-5) STD (Z = -2.083, p = .037). All patients reported subjective symptom improvement post-operatively. Thirteen patients experienced symptom recurrence at a median duration of 10 months post-operatively. CONCLUSIONS STD was associated with a reduction in the amount of shunt related procedures required in this group of patients with SVS. Further study is required to confirm this association.
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Affiliation(s)
- Laura Kehoe
- Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
- Beaumont Hospital Dublin, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - John Caird
- Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
- Beaumont Hospital Dublin, Dublin, Ireland
| | - Darach Crimmins
- Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
- Beaumont Hospital Dublin, Dublin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
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6
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Yan X, Zheng J, Tao X, Ma Y, Qin S. Slit Ventricle Syndrome. J Craniofac Surg 2023; 34:e566-e568. [PMID: 37226307 DOI: 10.1097/scs.0000000000009400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Slit ventricle syndrome (SVS) is a complication after ventriculoperitoneal shunt (VPS) or cystoperitoneal shunt(CPS), mostly due to excessive drainage of cerebrospinal. The disease is most often seen in children and has a complex pathogenesis. Clinical manifestations are mainly intermittent headache, slow refilling of the shunt reservoir, and slit-like ventricles on imaging. Surgery is the main treatment. We present a 22-year-old female patient with a previous 14-year history of CPS. The patient recently presented with typical symptoms but her ventricular morphology was normal. We performed VPS after diagnosis of SVS. After the surgery, the patient's symptoms improved and her condition was stable.
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Affiliation(s)
- Xuelei Yan
- School of Clinical Medicine, Weifang Medical University, Weifang
| | - Junfei Zheng
- School of Clinical Medicine, Weifang Medical University, Weifang
| | - Xiaowei Tao
- School of Clinical Medicine, Weifang Medical University, Weifang
| | - Yongqian Ma
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, Shandong, China
| | - Shiqiang Qin
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, Shandong, China
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Willoughby WR, Odéen H, Jones J, Bolding M. Magnetic Resonance Imaging of Focused Ultrasound Radiation Force Strain Fields for Discrimination of Solid and Liquid Phases. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1892-1900. [PMID: 37271680 DOI: 10.1016/j.ultrasmedbio.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/05/2023] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Focused ultrasound (FUS) has become a non-invasive option for some surgical procedures, including tumor ablation and thalamotomy. Extension of magnetic resonance (MR) imaging-guided focused ultrasound for ablation of slowly perfused cerebrovascular lesions requires a novel treatment monitoring method that does not rely on thermometry or high-frequency Doppler methods. The goal of this study was to evaluate the sensitivity and specificity of strain estimates based on MR acoustic radiation force imaging (MR-ARFI) for differentiation of solids and liquids. METHODS Strain fields were estimated in gelatin-based tissue-mimicking focused ultrasound phantoms on the basis of apparent displacement fields measured by MR-ARFI. MR-ARFI and diffusion-weighted imaging (DWI) measurements were made before and after FUS-induced heating to evaluate the performance of displacement, strain and apparent diffusion coefficient (ADC) measurements for the discrimination of solid and liquid phases. RESULTS As revealed by receiver operating characteristic analyses, axial normal strain and shear strain components performed significantly better than axial displacement measurements alone when predicting whether a gelatin had melted. Additional measurements must be made to estimate certain strain components, so this trade-off must be considered when developing clinical strategies. ADC had the best overall performance, but DWI is vulnerable to signal dropouts and susceptibility artifacts near cerebrovascular lesions, so this metric may have limited clinical applicability. CONCLUSION Strain components based on MR-ARFI apparent displacement measurements perform better than apparent displacement measurements alone at discriminating between solids and liquids. These methods are applicable to FUS treatment monitoring and evaluation of mechanical tissue properties in vivo.
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Affiliation(s)
| | - Henrik Odéen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jesse Jones
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Bolding
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Kumar S, Sahana D, Rathore L, Jain A, Sahu R. Extra-Axial Endoscopic Third Ventriculostomy for the Treatment of Slit Ventricle Syndrome: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e294-e295. [PMID: 36701743 DOI: 10.1227/ons.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sanjeev Kumar
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, India
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Pedersen SH, Prein TH, Ammar A, Grotenhuis A, Hamilton MG, Hansen TS, Kehler U, Rekate H, Thomale UW, Juhler M. How to define CSF overdrainage: a systematic literature review. Acta Neurochir (Wien) 2023; 165:429-441. [PMID: 36639536 DOI: 10.1007/s00701-022-05469-3] [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: 10/27/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Overdrainage (OD) is one of the most frequent complications related to drainage of the cerebrospinal fluid (CSF). It is mostly associated with valve-bearing shunt systems but should probably be considered as a risk factor in any type of CSF diversion procedure. There is extreme variation in the reported incidence of OD due to the lack of consensus on defining criteria and an unclear perception of the pathophysiology. Hence, OD is probably underreported and underestimated. The objective of this paper was to establish a definition of OD, based on a systematic review of the literature. METHODS A systematic search was conducted in MEDLNE and EMBASE. Studies providing a definition or a description of diagnostic findings related to OD in ventriculoperitoneal shunt treated hydrocephalus were included. Non-English titles, abstracts and manuscripts were excluded. Extracted descriptions were graded into five groups (class I-V studies) based on how precise the terminology used to describe OD was. Class I studies were included for further analysis and characteristics of OD were extracted. The quality of included descriptions was assessed by a clinical expert panel. RESULTS A total of 1309 studies were screened, 190 were graded into groups, and 22, which provided specific definitions or descriptions of OD, were graded as class I studies. We extracted 32 different characteristics consistent with OD (e.g., clinical symptoms, radiological signs, and syndromes). CONCLUSION There was an overall agreement that CSF overdrainage following implantation of a ventriculoperitoneal shunt in a mixed pediatric and adult population is characterized as a persistent condition with clinically manifestations as postural dependent headache, nausea, and vomiting and/or radiological signs of slim ventricles and/or subdural collections.
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Affiliation(s)
| | - Tobias Hannibal Prein
- Centre for Orthopaedic Research and Innovation, Slagelse Hospital, Slagelse, Denmark
| | - Ahmed Ammar
- Department of Neurosurgery, King Fahd University Hospital, Al Khobar, Saudi Arabia
| | | | - Mark G Hamilton
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Canada
| | | | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
| | - Harold Rekate
- The Donald and Barbara Zucker Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | | | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
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Ahmad SJ, Zampolin RL, Brook AL, Kobets AJ, Altschul DJ. A case of hydrocephalus confounded by suprasellar arachnoid cyst and concomitant reversible cerebral vasoconstriction syndrome. Surg Neurol Int 2022; 13:331. [PMID: 36128109 PMCID: PMC9479517 DOI: 10.25259/sni_313_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Obstructive hydrocephalus is a neurologic condition that has varied clinical and imaging presentations, as well as a multitude of congenital etiologies including aqueductal stenosis and less commonly arachnoid cysts. Aqueductal stenosis is a physical limitation to cerebrospinal fluid flow along the course of the aqueduct, which results in enlargement of the third and lateral ventricles. Arachnoid cysts are thin walled and fluid filled central nervous system lesions that can result in mass effect on adjacent structures. While arachnoid cysts are mostly asymptomatic, they may present with neurological symptoms that vary depending on the location of the lesion. Suprasellar cysts in particular may cause obstructive hydrocephalus as well as endocrine dysfunction. Reversible cerebral vasoconstriction syndrome (RCVS) is an unusual condition caused by cerebral arterial vasoconstriction that often presents initially with a thunderclap headache. Frequently, there is some environmental trigger associated with this condition. RCVS more commonly affects women and can induce stroke. Case Description: A 57-year-old female presented to the emergency department with progressive headache and visual changes. Initial workup suggested the patient’s symptoms where related to RCVS but subsequent surgical management of what was presumed to be long standing, compensated hydrocephalus resulted in resolution of the patient’s symptoms. Conclusion: We report, to the best of our knowledge, the first case of aquedutal stenosis and suprasellar arachnoid cyst with concomitant RCVS. The presence of multiple pathologies found on radiologic imaging illustrates the challenges presented by incidental findings and subsequent anchoring bias in medical diagnosis.
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Affiliation(s)
- Samuel Jack Ahmad
- Department of Neurosurgery, Albert Einstein College of Medicine, New York, United States
| | - Richard L. Zampolin
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Allan L. Brook
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Andrew J. Kobets
- Department of Neurosurgery, Montefiore Medical Center, Bronx, New York, United States
| | - David J. Altschul
- Department of Neurosurgery, Montefiore Medical Center, Bronx, New York, United States
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