Endoscopic Management for Recurrent Hydrocephalus Associated with Neurosarcoidosis

Area of Science:

• Neurosurgery
• Neurology
• Inflammatory diseases

Background:

• Recurrent hydrocephalus is a potential complication of neurosarcoidosis, a chronic inflammatory condition.
• Management often requires complex interventions due to the inflammatory nature of the disease.

Observation:

• A 34-year-old man with neurosarcoidosis presented with hydrocephalus and leptomeningeal enhancement.
• Initial endoscopic third ventriculostomy and biopsy were followed by shunt surgery due to stoma occlusion.
• Late-phase hydrocephalus developed despite immunosuppressive therapy, necessitating further endoscopic intervention.

Findings:

• Intraoperative findings revealed inflammatory tissue obstructing the ventricular system and shunt catheter.
• Multistage endoscopic procedures combined with shunt surgery successfully managed recurrent hydrocephalus.
• Treatment with a tumor necrosis factor-α inhibitor led to an uneventful course post-surgery.

Implications:

• Endoscopic cerebrospinal fluid diversion offers a viable alternative for hydrocephalus management, allowing simultaneous biopsy.
• Combining endoscopic techniques with shunts can prevent complex hydrocephalus in neurosarcoidosis.
• This case highlights the efficacy of tailored, multistage surgical and medical interventions for neurosarcoidosis-related hydrocephalus.