Neuropsychological Changes After Endoscopic Third Ventriculostomy for Long-Standing Overt Ventriculomegaly in Adults  -Case Report-

Hamada, Hideo; Hayashi, Nakamasa; Kurimoto, Masanori; Takaiwa, Akiko; Kurosaki, Kunikazu; Endo, Shunro

doi:10.2176/nmc.49.362

Cited by 12 publications

(20 citation statements)

References 8 publications

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“…The clinical onset of LOVA can occur at any stage in adulthood, with a range between 22 and 81 years (median 54) in our case series, which has been mirrored by others [4, 7, 8]. No clear-cut differences in patient sex have been identified thus far.…”

Section: Discussionsupporting

confidence: 80%

“…No clear-cut differences in patient sex have been identified thus far. Some series have identified a trend towards sub-normal IQ and cognitive abilities in LOVA patients, although this feature does not appear to be universal across all cases of LOVA [4, 7, 8]. Given the progressive nature of LOVA, early identification of patients with potential symptoms and signs of the condition is an attractive notion, as it may help to maximise the impact of any surgical intervention to implement it earlier in the disease process.…”

Section: Discussionmentioning

confidence: 99%

“…Mild short-term memory deficits in 1 patientSmall cohort; heterogeneous patient population, including three (50 %) patients <30 and one <20 (age 16). ETVs within the study cohort performed at two different institutionsHamanda et al (2009) [8]1 (1)ETV (1)Improvement in headaches, memory, cognitive and constructional abilitiesNoneSingle case report; patient had a history of operated myeloschisis and aqueductal stenosis as a child (potentially not a true case of LOVA)Jenkinson et al (2009) [6]24 (190)ETV (24)88 % (21) reporting improved symptoms after ETV9 post-ETV complications in the total cohort (5 %): 2 minor SDHs; 2 transient focal neurological deficits; 2 CSF leaks; 3 ICHs (2 necessitating EVD placement)Heterogeneity of indications for ETV; small numbers of patients in each subgroup; outcomes defined by clinical assessment in outpatient clinicAl Jumaily et al (2012) [4]20 (20)ETV (20)Improvement in headache (18; 90 %); improved balance (12; 80 %)Persistent headaches in 2 patients (10 %), requiring repeat ETV and gravitational shunt insertion, with persistence of symptoms despite shunt insertion in one patient. Two short seizures immediately post-operatively; poor cognitive performances persisted across the cohort post-ETVPatients failing to respond to ETV may have been suffering from non-ICP-related chronic daily headaches—however ICP monitoring was not performed to confirm thisOno et al (2012) [10]1 (1)Pressure programmable valve VP shunt (1)Improvement in memorySDH requiring drainage and second shunt insertionSingle case reportIssacs et al (2016)97 (163)ETV (163)130 (87 %) of total patient cohort reported improvement in symptoms at 3 months post-ETV10 (6 %): meningitis (4); SDH (2); focal neurological deficit (1); memory deficit (1); weight gain (2).…”

Section: Methodsmentioning

confidence: 99%

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Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA)

2016

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BackgroundLongstanding overt ventriculomegaly in adults (LOVA) is characterised by chronic hydrocephalus presumed to begin during infancy, but arresting before becoming clinically detectable. Later in life clinical features of hydrocephalus ensue, typically in the 5th or 6th decades. Only a relatively small number of LOVA case series have been published, and ambiguity remains regarding optimal management. This case series describes a series of patients with LOVA treated successfully at a single neurosurgical institution using endoscopic third ventriculostomy (ETV).MethodsA series of 14 patients were diagnosed with LOVA using established clinical and radiological criteria. All patients underwent an ETV and their clinical conditions were followed up for up to 5 years post-operatively.ResultsFourteen patients (100 %) reported either improvement or halt of progression in their presenting symptoms 3 months after ETV; 93 % of patients (n = 13) did not require any further surgical intervention. One patient (7 %) reported deterioration in symptoms beyond 3 months post-operatively, which necessitated further surgery (ventriculoperitoneal shunt). These promising outcomes after ETV are mirrored in numerous other LOVA case series. Other works have analysed the value of CSF shunting procedures in LOVA, with mixed results. A direct, prospective comparison of outcomes after shunt procedures and ETV, with a specific focus on LOVA patients, is yet to be completed. A minority of patients fail to respond, or develop recurrence of symptoms, months or years after initial surgical intervention.ConclusionsETV is an attractive option for surgical treatment of LOVA. After surgical treatment for LOVA, long-term follow-up should be considered to screen for late recurrence of the condition.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA)

2016

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“…It was decided to change GAV to ProGAV with concerns about underdrainage of GAV that have been reported. 6,7) The mental status deteriorated unexpectedly first postoperative day and follow-up CT showed severe ventriculomegaly. Emergent external ventricular drainage (EVD) was placed on left side and then the patient's neurological condition recovered.…”

Section: Casementioning

confidence: 98%

“…Secondly, detailed evaluation of cognitive function suggested by some authors was done only in two patients. 2,6,15) Thirdly, relevant studies were not sufficiently done such as cine phase-contrast MRI despite there is insufficient evidence to support the value in predicting response to shunting.…”

mentioning

confidence: 99%

Observations on the Activation of Chronic Compensated Hydrocephalus in Adult Patients

Jeon

Seo

Kwon

et al. 2012

Korean J Neurotrauma

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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. (Korean J Neurotrauma 2012;8:139-145) KEY WORDS: Hydrocephalus ㆍLong-standing overt ventriculomegaly in adult ㆍMacrocephaly ㆍAqueductal stenosis.

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Ruptured Sylvian arachnoid cysts: an update on a real problem

et al. 2022

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Purpose Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe. No definite information is available on its occurrence or management. The goal of the present article is to provide an update on the epidemiological, etiological, and clinical aspects and the management of this peculiar clinical condition. Methods A comprehensive review of the English literature of the last 40 years on this topic has been realized. Moreover, a personal series of children investigated and treated in the last 20 years is presented. These patients were managed as follows: (1) treatment of the subdural collection; (2) identification of candidates for surgical treatment of the residual cyst (brain MRI, perfusion brain MRI, prolonged invasive ICP monitoring (selected cases), EEG, neuropsychological tests); (3) surgical treatment of the cyst in the patients with pathological perfusion MRI and/or ICP measurement and/or clear neurophysiological and neuropsychological correlations. Results A total of 446 patients (430 from the literature and 16 from the personal series), mainly children, adolescents, and young adults, have been analyzed leading to the following results: (1) SAC rupture is rare but not negligible (yearly risk of rupture: 0.04%; overall risk up to 10% in children affected by SCAs). Prophylactic surgery in asymptomatic cases is not advisable. (2) The mechanism of rupture is not known but an impact of SAC against the sphenoid wing and/or a direct injury on SAC through a thinned temporal bone, with possible laceration of the cyst wall vessels and/or tear of the bridging veins, can be hypothesized. A head injury is often not reported (may be misdiagnosed). (3) Subdural collection (hygroma > chronic hematoma) is the most common finding followed by intracystic bleeding, extradural hematoma, and other types of bleeding. Signs or symptoms of raised intracranial pressure are the most frequent ones. (4) The complication of the rupture is usually treated in emergency or in the acute period by burr hole or craniotomic evacuation of the subdural collection, although a conservative management is possible in some cases. Following the rupture, the majority of SACs are treated (70%), often at the same time of the complication, but no specific investigations are routinely performed to select candidates. According to our protocol, only 43.7% of SACs needed to be treated. Conclusions The “spontaneous” or posttraumatic rupture of SACs is a rare but potentially significant complication followed by a generally good outcome. The course of the cyst is independent from the outcome of the complication, consequently requiring specific investigations for individuating those lesions interfering with CSF dynamics and/or cerebral blood flow.

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Neuropsychological Changes After Endoscopic Third Ventriculostomy for Long-Standing Overt Ventriculomegaly in Adults -Case Report-

Cited by 12 publications

References 8 publications

Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA)

Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA)

Observations on the Activation of Chronic Compensated Hydrocephalus in Adult Patients

Ruptured Sylvian arachnoid cysts: an update on a real problem

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