Obstructive hydrocephalus caused by an unruptured arteriovenous malformation successfully treated by endoscopic third ventriculostomy after shunt dysfunction.

Abstract

The authors report on a patient harbouring an unruptured cortical arteriovenous malformation (AVM), who had presented with obstructive hydrocephalus due to compression of the cerebral aqueduct by a large venous varix. A ventriculoperitoneal (VP) shunt was inserted in emergency. Due to its large volume, the AVM was not referred for treatment and a follow-up policy was chosen. After the second VP shunt dysfunction, endoscopic third ventriculostomy was performed under neuronavigation. The procedure went uneventfully and the patient recovered well. In the rare eventuality of obstructive hydrocephalous caused by an unruptured AVM, endoscopic third ventriculostomy is feasible, efficient and can avoid shunt-related complications.

Late Discovery of a Vein of Galen Aneurysmal Malformation Complicated with Hydrocephalus: A Case Report

“…[7] series, out of seven patients operated on for hydrocephalus complicating a Galen's ampulla malformation, six ventriculo-peritoneal shunting showed severe postoperative complications. Therefore, ventriculo-peritoneal shunting should be limited to cases of symptomatic hydrocephalus in which the patient is a poor candidate for embolization or in cases where endovascular treatment has already been optimized [11]. Our patient was received in the hospital with an acute hydrocephalus and a ventriculo-peritoneal shunt seemed to be the best therapeutic indication in our context.…”

Galen Vein Aneurysm: Problem of Management in an Under-Equipped Neurosurgical Environment about a Case and Review of the Literature

“…All the mentioned options were not done in our case, due to the lack of the adequate technical platform; Consequently, we considered the installation of a ventriculoperitoneal bypass system which seemed to relieve our patient, however the literature mentions that DVP would be one of the factors increasing the bleeding and exacerbating of symptoms in Galen vein aneurysm [2]. Some authors [9] advocate ETV as a fairly recent alternative to shunt implantation, mainly used in obstructive hydrocephalus with a global success rate of around 75% and a low complication rate of less than 5%.…”

Case Report of an Obstructive Hydrocephalus Caused by an Unruptured Mesencephalic Arteriovenous Malformation in a Boy and a Review of Literature

“…Hydrocephalus can occur as a result of the venous outflow and hemodynamic unbalance [ 5 , 8 , 10 ]; or mechanical obstruction of the ventricles by drainage vein or AVM [ 5 , 7 ], or by compression of the aqueduct [ 5 , 15 - 17 ] in unruptured AVM cases. Ebuni et al [ 18 ] suggested that hydrocephalus was result of reflux into periventricular and transmedullary veins instead of mechanical obstruction in their study.…”

“…Obstructive hydrocephalus due to an AVM can be treated by a VP shunting [ 5 , 18 , 21 ] or ETV [ 6 , 15 , 22 ]. ETV is a technique which would not involve a change between supratentorial and infratentorial pressure relationships [ 7 ] and it considered as an advantage for being “shunt free” [ 15 ]. Malfunctioning or over drainage may be seen following VP shunting [ 5 ].…”