J Korean Neurosurg Soc.  2012 Sep;52(3):270-272.

Treatment of Hydrocephalus Associated with Neurosarcoidosis by Multiple Shunt Placement

• Kim SH
• Lee SW
• Sung SK
• Son DW

Abstract

A 31-year-old man was admitted to our hospital due to hydrocephalus with neurosarcoidosis. Ventriculo-peritoneal shunting was performed in the right lateral ventricle with intravenous methylprednisolone. Subsequently, after 4 months, additional ventriculo-peritoneal shunting in the left lateral ventricle was performed due to the enlarged left lateral ventricle and slit-like right lateral ventricle. After 6 months, he was re-admitted due to upward gaze palsy, and magnetic resonance image showed an isolated fourth ventricle with both the inlet and outlet of fourth ventricle obstructed by recurrent neurosarcoidosis. Owing to the difficulty of using an endoscope, we performed neuronavigator-guided ventriculo-peritoneal shunting via the left lateral transcerebellar approach for the treatment of the isolated fourth ventricle with intravenous methyl prednisolone. The patient was discharged with improved neurological status.

Keyword

Neurosarcoidosis; Hydrocephalus; Ventriculoperitoneal shunt

MeSH Terms

Adult
Bays
Central Nervous System Diseases
Endoscopes
Fourth Ventricle
Humans
Hydrocephalus
Lateral Ventricles
Magnetic Resonance Spectroscopy
Methylprednisolone
Paralysis
Prednisolone
Sarcoidosis
Ventriculoperitoneal Shunt
Central Nervous System Diseases
Methylprednisolone
Prednisolone
Sarcoidosis

Figure

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  Fig. 1 Non enhanced computed tomography showing enlarged ventricles with periventricular edema (A) and Gadolinium-enhanced magnetic resonance image showing enhanced lesions in septum pellucidum, infundibulum, aqueduct, corpus callosum, leptomeninges (B). Biopsy specimen shows noncaseating granulomas (H&E, ×200) (C).

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  Fig. 2 Non enhanced computed tomography showing enlarged left lateral ventricle with decreased size of right ventricle inserted by catheter (A) and additional shunt catheter in left ventricle (B).

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  Fig. 3 Non enhanced computed tomography and showing both collapsed lateral ventricles following shunting (A), enlarged fourth ventricle with periventricular edema (B). Gadolinium-enhanced magnetic resonance image showing another enhanced lesions in the left occipital lobe (arrow) (C) and left cerebellar peduncle (arrow) (D).

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  Fig. 4 Follow-up non-enhanced computed tomography scan showing catheter in the fourth ventricle (A) and decreased size of the fourth ventricle (B).

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