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J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e242-e247
DOI: 10.1055/s-0033-1349339
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Acute Decompensation of Noncommunicating Hydrocephalus Caused by Dilated Virchow-Robin Spaces Type III in a Woman Treated by Endoscopic Third Ventriculostomy: A Case Report and Review of the Literature

Malte Ottenhausen
1   Clinic for Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany
,
Ullrich Meier
1   Clinic for Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany
,
Anja Tittel
2   Institute for Radiology, Unfallkrankenhaus Berlin, Berlin, Germany
,
Johannes Lemcke
1   Clinic for Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany
› Author Affiliations
Further Information

Publication History

22 August 2012

04 March 2013

Publication Date:
08 August 2013 (online)

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Abstract

Background and Importance Even though dilated Virchow-Robin spaces (VRS) are a very rare entity, they can compel the clinician to start immediate intervention in the case of acute onset of symptoms. To allow a well-balanced management decision, we compiled a summary of all cases published in the literature and discuss the different methods and indications for neurosurgical intervention in relation to dilated VRS.

Clinical Presentation We report a case of a 43-year-old female patient who came to admission after syncope with a history of unspecific neck pain, fatigue, diplopia, and dizziness. Dilated VRS type III causing a noncommunicating hydrocephalus were found to be responsible. Although the patient was initially awake, within 72 hours after admission, a deterioration of consciousness and repeated vomiting were observed. The patient underwent an urgent endoscopic third ventriculostomy (ETV) and was discharged in a good condition.

Conclusion To the best of our knowledge, the case presented here is the first case of acute decompensation of a noncommunicating hydrocephalus caused by dilated VRS. Neurosurgical intervention is required in cases of noncommunicating hydrocephalus caused by giant tumefactive VRS. The treatment options are mono- or biventricular shunt surgery or ETV. Because ETV provides the possibility of cyst fenestration and membrane sampling, it appears to be the most advantageous treatment option.

Keywords

hydrocephalus - Virchow-Robin spaces - ETV
 

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