Endoscopic Third Ventriculostomy in a 12-Year-Old With Recurrent Failure of Ventriculoperitoneal Shunts

With a success rate of about 80%, ventriculoperitoneal (VP) shunts are widely used for the treatment of hydrocephalus. Whether congenital or acquired, hydrocephalus is not a single disease entity. It can be caused by abnormal cerebrospinal fluid (CSF) reabsorption, obstruction along the ventricular pathways, or, very rarely, increased production of CSF itself. This case presents a patient with a history of congenital hydrocephalus with multiple failed VP shunts. Through various clinical examinations and diagnostic measures, an endoscopic third ventriculostomy was eventually performed. This case highlights the rare complications, yet a large possibility, that can lead to failure of VP shunts in more than one way and when it is appropriate for shunt reversal versus removal.

Intracranial Hematoma After Ventriculoperitoneal Shunt Placement in a Patient With Factor V Deficiency: A Rare Case Report

Congenital factor V deficiency (FVD) is a rare bleeding disorder due to an inherited mutation. So far, there are no standard protocols for pre- and peri-operative management of patients with factor V deficiency. This poses a challenge for surgeons and requires a multidisciplinary approach. We present a case of a 60-year-old woman with factor V deficiency admitted to the neurosurgery department of Ibn Tofail Hospital for hydrocephalus requiring a ventriculoperitoneal shunt. Pre-operative management of the patients as well as outcome and follow-up are described and compared with relevant literature.

Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus (NPH) occurs when there is an accumulation of cerebrospinal fluid due to impeded flow or excess production, resulting in gait and memory impairment and urinary incontinence. The authors present the case of a 67-year-old male, who had symptoms for a year prior to being diagnosed. His neurological exam was significant for a slow, and unsteady wide-based gait. No underlying cause for his NPH was found. He underwent a shunt procedure following which he made a complete recovery.

Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report

Normal pressure hydrocephalus (NPH) is a rare condition characterized by pathologically enlarged ventricles and a normal cerebrospinal fluid (CSF) opening pressure measured by lumbar puncture. NPH typically presents as a triad of cognitive decline, gait disturbance, and urinary incontinence. Rarely, NPH can present with bulbar involvement, particularly with difficulty swallowing. Here, we present a case of NPH in a 75-year-old man who presented with an episode of choking and a recent onset of swallowing difficulties with a three-month history of ataxia and progressive memory loss. His CT scan revealed ventriculomegaly, which was consistent with the clinical presentation of NPH and was further confirmed by a normal opening pressure on the CSF tap. Furthermore, ventriculoperitoneal shunts showed a marked improvement in patients' dysphagia and the classical triad of NPH symptoms. Through this case report, we want to highlight that NPH can present as a difficulty in swallowing.

Obstructive Hydrocephalus Secondary to Cryptococcal Meningitis in an Immunocompetent Adult

Cryptococcal infections of the central nervous system (CNS) are common opportunistic infections in immunocompromised hosts. They can occur in immunocompetent hosts, and this has been documented in isolated case reports. Rapid neurological deterioration can be seen, particularly with hydrocephalus, and diagnosis can be difficult without a high index of suspicion. Treatment arms include prolonged antifungal therapy and cerebrospinal fluid (CSF) diversion procedures.

We present a case of a middle-aged immunocompetent male, who presented with an acute confusional state and papilledema. An urgent computed tomography (CT) and magnetic resonance imaging (MRI) revealed obstructive hydrocephalus, and an external ventricular drain was placed. CSF samples were collected, and analysis revealed cryptococcal infection. He was treated with antifungal therapy but failed external ventricular drain challenging. A ventriculoperitoneal shunt was placed after negative CSF studies were obtained.

While uncommon, cryptococcal meningitis in immunocompetent hosts can present with obstructive hydrocephalus. It can result in rapid neurological decline and death. Emergent CSF diversion and antifungal therapy are the primary treatment modalities. CSF diversion may be permanently required in some cases.

A Rare Case of Intraparenchymal Cerebrospinal Fluid Cyst Associated With Ventriculoperitoneal Shunt in an Adult Patient

Here we are reporting a rare phenomenon associated with ventriculoperitoneal (VP) shunt in the adult patient, namely, the development and finding of intraparenchymal pericatheter cerebrospinal fluid cyst. Our patient had a VP shunt placed for idiopathic intracranial hypertension 16 years ago before presentation to the hospital. The patient was admitted to the hospital for headache for past three weeks with the initial CT scan showing encephalomalacia and vasogenic edema. MRI showed the presence of a 4-cm intraparenchymal cyst in the right frontal lobe with surrounding vasogenic edema. The patient underwent two surgeries with the initial surgery for the drainage of cyst and second surgery for the placement of the cystoperitoneal shunt. Catheter-associated cysts are easily misdiagnosed due to their similarity in appearance to abscesses and other malignancies on imaging, and there are no guidelines yet on their evaluation and management. This is a unique case as the pericatheter cyst developed 16 years after the initial VP shunt placed. Given the rarity of this presentation, we hope that our case report can contribute to the development of guidelines and treatment options in adults with long-standing VP shunts.

Management of Pre-existing Ventriculoperitoneal Shunt in Posterior Vault Distraction for Lambdoid Craniosynostosis: A Case Report and Technical Note

Posterior vault distraction osteogenesis (DO) is an emerging treatment option for craniosynostosis. Operative nuances detailing surgical management are being described with increasing use and experience. In this article, we discuss the surgical management of an 8-month-old male with a ventriculoperitoneal shunt (VPS) diagnosed with bilateral lambdoid craniosynostosis and Chiari I malformation. The patient underwent successful bilateral posterior fossa DO without surgical re-implantation of the shunt. Pre- and post-operative imaging confirmed no migration of the VPS. Intracranial volume increased by 20.1% and posterior fossa volume increased by 39.9%. Our experience illustrates that posterior vault DO can be done safely in the setting of a parieto-occipital VPS, in a single operative setting, without the need of additional procedures.

Obstructive hydrocephalus and facial nerve palsy secondary to vertebrobasilar dolichoectasia: Case Report

Background:

Symptomatic hydrocephalus due to vertebrobasilar dolichoectasia is a rare occurrence.

Case Description:

We report a patient who presented with acute confusion and vomiting. Neuroimaging revealed elongated and tortuous basilar artery indenting and elevating the floor of third ventricle causing obstructive hydrocephalus. Initially, the patient was treated with external ventricular drain and then with ventriculo-peritoneal shunt.

Conclusion:

We suggest prompt surgical intervention upon diagnosis as a first choice of treatment in order to avoid further complications.