Reversible transinsular herniation of the lateral ventricle

Area of Science:

• Neuroscience
• Pediatric Neurosurgery
• Medical Imaging

Background:

• Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain.
• Neonatal intraventricular hemorrhage can lead to hydrocephalus, often requiring surgical intervention with shunts.
• Shunt revisions are common in managing pediatric hydrocephalus due to potential complications.

Observation:

• A 7-year-old boy with a history of hydrocephalus and multiple shunt revisions presented with shunt failure.
• Radiological imaging revealed herniation of the lateral ventricle trigone into the posterior fossa, a dramatic finding.
• Despite the unusual imaging, the patient exhibited no new clinical signs beyond typical hydrocephalus symptoms.

Findings:

• The herniation of the lateral ventricle trigone was a radiological finding without corresponding clinical deterioration.
• Successful shunt revision led to the resolution of hydrocephalus and the normalization of the trigone's position.
• A second similar case was also documented, suggesting this phenomenon may occur in specific hydrocephalus contexts.

Implications:

• This case highlights that dramatic radiological findings in pediatric hydrocephalus may not always correlate with acute clinical decline.
• It underscores the importance of shunt function in managing hydrocephalus and preventing complications like trigone herniation.
• Understanding such radiological-clinical discrepancies is crucial for accurate diagnosis and treatment planning in pediatric neurosurgery.