Case of Obstructive Hydrocephalus successfully treated surgically

Dr David R. Santiago-Dieppa at the University of California, San Diego, La Jolla, CA and colleagues have reported a case of Obstructive Hydrocephalus. The case has appeared in the New England Journal of Medicine.

Obstructive hydrocephalus is a term usually used to denote obstructive non-communicating hydrocephalus.

It is actually a term that causes confusion as used in the above sense implies that communicating hydrocephalus does not have an obstruction to CSF flow/absorption; this is not true as the majority of cases of communicating hydrocephalus have obstruction to CSF flow through the subarachnoid space or impaired absorption at the arachnoid granulations.

The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus" meaning head. As the name implies, it is a condition in which the primary characteristic is an excessive accumulation of fluid in the brain. Although hydrocephalus was once known as "water on the brain," the "water" is actually cerebrospinal fluid (CSF) — a clear fluid that surrounds the brain and spinal cord. The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles.

A 4-year-old girl with a 2-week history of progressive headache, nausea, vomiting, and irritability was brought to the emergency department. The patient was confused and combative. She had disconjugate gaze on extraocular examination and also had an unsteady, uncoordinated gait. Contrast-enhanced T1-weighted magnetic resonance imaging revealed a cystic mass measuring 3.4 cm by 3.9 cm by 4.4 cm in the quadrigeminal cistern, arising from the tectal plate and compressing the cerebral aqueduct (Panel A).

Its presence resulted in obstructive hydrocephalus and bowing of the corpus callosum. Transependymal flow of the cerebrospinal fluid (CSF) was seen on the axial T2-weighted FLAIR (fluid-attenuated inversion recovery) sequences (Panel B). The patient underwent placement of an external ventricular drain, tumour resection, and endoscopic third ventriculostomy.

Histologic examination of the tumor specimen led to a diagnosis of pilocytic astrocytoma. After surgery, the patient had complete resolution of her symptoms, and adjuvant chemotherapy was initiated. At follow-up 9 months after the surgery, the hydrocephalus had resolved without recurrence, and no further diversion of the CSF was required.

For more details click on the link: DOI: 10.1056/NEJMicm1815973