Korean J Neurotrauma.  2012 Oct;8(2):139-145. 10.13004/kjnt.2012.8.2.139.

Observations on the Activation of Chronic Compensated Hydrocephalus in Adult Patients

• Jeon SI
• Seo DH
• Kwon YS
• Choe IS
• Park SC

• KMID: 1427728
• DOI: http://doi.org/10.13004/kjnt.2012.8.2.139

Abstract

OBJECTIVE
There is a broad spectrum of compensated hydrocephalus. Various terms such as long-standing overt ventriculomegaly in adult (LOVA) has been coined, however, even such terms leave diverse aspect of this condition out of account. We have experienced compensated hydrocephalus cases which were considered to be activated after a long time period of quiescent state, and tried to compare their clinical characteristics with the relatively well described entity of LOVA.
METHODS
We conducted a retrospective review of 206 patients who underwent ventriculoperitoneal shunt (VPS) between February 2001 and May 2012. Of these, 6 patients had chronic compensated hydrocephalus. The clinical and radiological characteristics are evaluated.
RESULTS
Definite triventriculomegaly was observed in two patients. Macrocephaly was observed in two cases, one with aqueductal stenosis (AS), the other with unknown status of aqueduct. All of the cases with triventriculomegaly were normocephalic. Spinal causes were thought as aggravating factor in two. Two endoscopic third ventriculostomy and eight VPS were performed in five patients. Four patients responded well but one took a very complicated course.
CONCLUSION
The relationships between macrocephaly, triventriculomegaly, and AS suggested in other studies were inconsistent. Blockage or narrowing of cerebrospinal fluid pathways were observed at various sites. Disturbances of spinal arachnoid pathways were related to the activation in some cases. Treatment is to be tailored individually considering various reigniting event. It is suggested that this entity is to be evaluated for better nomenclature reflecting diverse aspects of this condition. Further study is needed to elucidate underlying pathophysiology and effective management.

Keyword

Hydrocephalus; Long-standing overt ventriculomegaly in adult; Macrocephaly; Aqueductal stenosis

MeSH Terms

Adult
Arachnoid
Humans
Hydrocephalus
Macrocephaly
Numismatics
Retrospective Studies
Ventriculoperitoneal Shunt
Ventriculostomy

Figure

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  FIGURE 1. CT/MRI axial scans demonstrating ventriculomegaly with relatively well-identified sulci. Periventricular edema is observed in case 4 which suggest acute aggravation of quiescent long-standing hydrocephlalic process. CT: computed tomography, MRI: magnetic resonance imaging

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  FIGURE 2. T2-weighted sagittal MRI showing persistent T10-L2 segmental arachnoid cyst (A), MRI taken before ETV show AS, sellar enlargement, upwardly stretched corpus callosum and periventricular edema (B), ETV was performed and the fenestration was enlarged using a 3-French Fogarty balloon catheter. Unexpectedly, third ventricular floor was very narrow and the membrane was thick (C, arrow). AS: aqueductal stenosis, ETV: endoscopic third ventriculostomy, MRI: magnetic resonance imaging.

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  FIGURE 3. Preoperative MRI demonstrating triventriculomegaly, empty sella and abrupt narrowing distal to the aqueduct (A, arrow). Thoracic spine MRI revealed about 18 cm length epidural lesion (B). MRI: magnetic resonance imaging.

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  FIGURE 4. MRI showing ventriculomegaly and abrupt narrowing at the foramen of Magendie level (arrow) suggesting obstructive hydrocephalus (A). Radioisotope cisternography shows communicating type hydrocephalus (B).

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