Endoscopic third ventriculotomy improves Parkinsonism following a ventriculo-peritoneal shunt in a patient with non communicating hydrocephalus secondary to idiopathic aqueduct stenosis

Transtentorial Fluctuations and Atypical Parkinsonism After Ventriculo-Peritoneal Shunting

“…Dorsal midbrain compression by the pineal tumor caused aqueductal stenosis in this patient and could have contributed to the midbrain syndrome as well. Similar to previously reported cases, 3,[5][6][7] Parkinsonism and oculomotor abnormalities stabilized but persisted after transtentorial fluctuations resolved. This persistence might reflect irreversible damage to dorsal midbrain structures and their connections.…”

“…The exact pathophysiology is unknown, but it likely results from mechanical damage due to dorsal midbrain structures and their connections. [1][2][3][4][5][6][7][8] Here, we describe two patients who developed progressively worsening transtentorial pressure fluctuations, Parkinsonism, and oculomotor abnormalities after VPS.…”

“…As previously reported, downstream frontal lobe dysfunction might be associated with levodopa-resistant Parkinsonism in these patients. 5 Remarkably, therapeutic attempts to recalibrate VPS settings were associated with progressive worsening in transtentorial pressure fluctuations and further midbrain displacement in the opposite direction. In Case 1, the fluctuations became clinically evident 1 year after VPS placement for congenital aqueductal stenosis.…”

Long‐standing overt ventriculomegaly without aqueductal stenosis: A case report

“…1 Because aqueductal stenosis has been seen in most patients and thought to be the cause of the disease, ETV is the first choice of treatment. 1,3,4 In our case, the aqueduct was patent; however, ETV partly ameliorated her symptoms. It may suggest that functional aqueductal stenosis was compensated by a bypass made by ETV between the third ventricle and basilar cistern.…”

“…Our case met the diagnostic criteria of LOVA . Because aqueductal stenosis has been seen in most patients and thought to be the cause of the disease, ETV is the first choice of treatment …”