Overshunting-Associated Myelopathy Treated with Endoscopic Third Ventriculostomy.
Cerebrospinal fluid shunt
Complication
Hydrocephalus
Myelopathy
Overdrainage
Paravertebral venous plexus
Ventriculoperitoneal shunt
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
13
08
2019
revised:
28
10
2019
accepted:
29
10
2019
pubmed:
11
11
2019
medline:
7
3
2020
entrez:
10
11
2019
Statut:
ppublish
Résumé
Overshunting-associated myelopathy (OSAM) is a rare complication of cerebrospinal fluid shunt placement. Previous reports have recommended removal or ligation of the shunt and use or revision of a pressure programmable valve to treat OSAM. We present a rare case of OSAM successfully treated with endoscopic third ventriculostomy (ETV). A 67-year-old female who had undergone ventriculoperitoneal shunting with a constant pressure valve for long-standing overt ventriculomegaly in adults 42 years ago presented to our department with bilateral hand numbness. Magnetic resonance imaging of the cervical spine showed spinal canal stenosis and dilatation of the paravertebral venous plexus with spinal cord compression. Cervical laminoplasty was temporarily effective, but her symptoms reoccurred and worsened. ETV was performed, and a programmable shunt valve adjusted to maximum pressure was also interposed as a safety device. Her symptoms immediately improved after this operation. Cervical magnetic resonance imaging and computed tomography showed that the cervical paravertebral venous dilatation had also resolved immediately. Clinical improvement was maintained with no recurrence of hydrocephalus or paravertebral venous dilatation for 2 years postoperatively. This is the first case of OSAM treated with ETV. ETV might be a useful treatment option for OSAM after treatment for obstructive hydrocephalus.
Sections du résumé
BACKGROUND
BACKGROUND
Overshunting-associated myelopathy (OSAM) is a rare complication of cerebrospinal fluid shunt placement. Previous reports have recommended removal or ligation of the shunt and use or revision of a pressure programmable valve to treat OSAM. We present a rare case of OSAM successfully treated with endoscopic third ventriculostomy (ETV).
CASE DESCRIPTION
METHODS
A 67-year-old female who had undergone ventriculoperitoneal shunting with a constant pressure valve for long-standing overt ventriculomegaly in adults 42 years ago presented to our department with bilateral hand numbness. Magnetic resonance imaging of the cervical spine showed spinal canal stenosis and dilatation of the paravertebral venous plexus with spinal cord compression. Cervical laminoplasty was temporarily effective, but her symptoms reoccurred and worsened. ETV was performed, and a programmable shunt valve adjusted to maximum pressure was also interposed as a safety device. Her symptoms immediately improved after this operation. Cervical magnetic resonance imaging and computed tomography showed that the cervical paravertebral venous dilatation had also resolved immediately. Clinical improvement was maintained with no recurrence of hydrocephalus or paravertebral venous dilatation for 2 years postoperatively.
CONCLUSIONS
CONCLUSIONS
This is the first case of OSAM treated with ETV. ETV might be a useful treatment option for OSAM after treatment for obstructive hydrocephalus.
Identifiants
pubmed: 31704357
pii: S1878-8750(19)32821-9
doi: 10.1016/j.wneu.2019.10.183
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
133-136Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.