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DOI: 10.1055/s-0032-1315792
Obstructive Hydrocephalus due to Vertebrobasilar Dolichoectasia: Diagnostic and Therapeutic Considerations
Publikationsverlauf
07. Dezember 2011
05. Januar 2012
Publikationsdatum:
21. August 2012 (online)
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Abstract
Background Obstructive hydrocephalus caused by vertebrobasilar dolichoectasia is an extremely rare entity. Cerebrospinal fluid pathway obstruction may be localized at the level of either the foramina of Monro or the cerebral aqueduct. Radiological imaging can sometimes be misleading in establishing the precise location of the obstruction, which is crucial in determining the optimal surgical strategy. We report such a case with diagnostic challenges and also present a review of previously reported cases with a special focus on diagnostic and therapeutic controversies.
Case Description We present a patient with an obstructive hydrocephalus associated with a dolichoectatic basilar artery extending to the level of the foramina of Monro. Although computed tomography angiography findings indicate bilateral occlusion of the foramina of Monro by the posterior cerebral arteries, mild but suspicious dilatation of the third ventricle raised concerns about the precise location of the obstruction. Endoscopic exploration of the right foramen of Monro was performed not only to clarify questionable radiological findings but also to be prepared to make a septostomy prior to monoventriculoperitoneal shunting if exploration would confirm occlusion of the foramina of Monro. However, the right foramen of Monro was documented to be patent during surgery and the cerebral aqueduct was considered to be the location of obstruction. The procedure was accomplished with monoventriculoperitoneal shunting, which achieved a full recovery immediately after the operation.
Conclusions Our current experience and the literature review highlight the usefulness of neuroendoscopy as a diagnostic and therapeutic solution, particularly in cases considered to have obstructive hydrocephalus caused by compression of the foramina of Monro by dolichoectatic basilar artery.
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References
- 1 Breig A, Ekbom K, Greitz T, Kugelberg E. Hydrocephalus due to elongated basilar artery. A new clinicoradiological syndrome. Lancet 1967; 1 (7495) 874-875
- 2 Ekbom K, Greitz T, Kugelberg E. Hydrocephalus due to ectasia of the basilar artery. J Neurol Sci 1969; 8 (3) 465-477
- 3 Greitz T, Ekbom K, Kugelberg E, Breig A. Occult hydrocephalus due to ectasia of the basilar artery. Acta Radiol Diagn (Stockh) 1969; 9: 310-316
- 4 Rozario RA, Levine HL, Scott RM. Obstructive hydrocephalus secondary to an ectatic basilar artery. Surg Neurol 1978; 9 (1) 31-34
- 5 Aiba T, Nakazawa T. Non-communicating hydrocephalus due to megadolichobasilar artery—case report. Neurol Med Chir (Tokyo) 1995; 35 (2) 104-106
- 6 Siddiqui A, Chew NS, Miszkiel K. Vertebrobasilar dolichoectasia: a rare cause of obstructive hydrocephalus: case report. Br J Radiol 2008; 81 (964) e123-e126
- 7 Kansal R, Mahore A, Dange N, Kukreja S. Dolichoectasia of vertebrobasilar arteries as a cause of hydrocephalus. J Neurosci Rural Pract 2011; 2 (1) 62-64
- 8 Branco G, Goulão A, Ferro JM. MRI in aqueduct compression and obstructive hydrocephalus due to an ecstatic basilar artery. Neuroradiology 1993; 35 (6) 447-448
- 9 Ricci G, Lenzi J, Esposito V. Hydrocephalus caused by dolichoectatic basilar artery. Case report. J Neurosurg Sci 2000; 44 (3) 155-158
- 10 Thiex R, Mull M. Basilar megadolicho trunk causing obstructive hydrocephalus at the foramina of Monro. Surg Neurol 2006; 65 (2) 199-201
- 11 Healy JF, Wells MV, Rosenkrantz H. Computed tomographic demonstration of enlarged, ectatic basilar artery associated with obstruction of the anterior third ventricle. Comput Tomogr 1981; 5 (4) 239-245
- 12 Weber MA, Steiner T, Fiebach J. [Unusual cause of acute impairment of consciousness. Decompensated hydrocephalus caused by blockage of the foramini Monroi due to enlarged basilar artery]. Radiologe 2002; 42 (10) 833-836