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Symptomatic obstructive hydrocephalus caused by choroid plexus hyperplasia in a pediatric patient: illustrative case
Ana Sofia Alvarez1, John P McGinnis2, Rajan Patel2
11Department of Neurosurgery, Fundacion Jimenez Diaz University Hospital, Madrid, Spain.
Insights
Choroid plexus hyperplasia can cause obstructive hydrocephalus by blocking the aqueduct. Endoscopic third ventriculostomy (ETV) effectively treated this condition in a pediatric patient, resolving symptoms.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Choroid plexus hyperplasia is a rare cause of communicating hydrocephalus.
- This case is the first to report obstructive hydrocephalus due to choroid plexus hyperplasia mechanically obstructing the aqueduct.
Purpose of the Study:
- To report a case of symptomatic obstructive hydrocephalus caused by choroid plexus hyperplasia.
- To evaluate the efficacy of endoscopic third ventriculostomy (ETV) in treating this condition.
Main Methods:
- A 4-year-old male presented with symptoms of hydrocephalus.
- Brain MRI revealed enlarged choroid plexus obstructing the aqueduct of Sylvius.
- The patient underwent successful endoscopic third ventriculostomy (ETV).
Main Results:
- Postoperative MRI confirmed a patent third ventriculostomy and reduced ventricular size.
- The patient experienced complete resolution of headaches and emesis.
- No complications were observed after the ETV procedure.
Conclusions:
- Choroid plexus hyperplasia can lead to obstructive hydrocephalus.
- Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus caused by choroid plexus hyperplasia.
- Pressure changes during ETV may help "uncork" the aqueduct, facilitating cerebrospinal fluid (CSF) flow.
Background:
Choroid plexus hyperplasia has been described as a rare cause of communicating hydrocephalus due to cerebrospinal fluid (CSF) overproduction. However, this is the first report of symptomatic obstructive hydrocephalus caused by mechanical obstruction of the aqueduct by a hyperplastic choroid plexus.
Observations:
A 4-year-old male presented with headaches and intermittent emesis. Magnetic resonance imaging (MRI) of the brain showed abnormal enlargement of the choroid plexus in the lateral ventricles with extension into the third ventricle, resulting in obstruction of the aqueduct of Sylvius, leading to obstructive hydrocephalus. Endoscopic third ventriculostomy (ETV) was chosen as the surgical treatment. During the procedure, high pressure flow of clear CSF was noted. Normal intraventricular anatomy was identified, and no cyst or tumor was found. The postoperative MRI showed a patent third ventriculostomy, without complication, and a significant decrease in supratentorial ventricular size. The patient was discharged 3 days after surgery with a complete resolution of symptoms.
Lessons:
Choroid plexus hyperplasia has the potential to cause obstructive hydrocephalus, and it can be effectively treated with ETV. Our hypothesis is that the change in pressure caused by the procedure may have led to an uncorking of the aqueduct by the hyperplastic choroid plexus, contributing to the observed improvement.
