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[Extraventricular obstructive hydrocephalus]

S Biedert1, H Wolfshörndl

  • 1Neurologische Abteilung, Psychiatrisches Landeskrankenhaus Wiesloch.

Fortschritte Der Neurologie-Psychiatrie
|November 1, 1994
PubMed
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Extraventricular obstructive hydrocephalus (EVOH) can be treated with shunt surgery, even in complex cases. This study shows favorable outcomes in idiopathic EVOH, offering hope when other treatments fail.

Area of Science:

  • Neurology
  • Neurosurgery
  • Hydrocephalus Research

Background:

  • Extraventricular obstructive hydrocephalus (EVOH) involves impaired cerebrospinal fluid (CSF) outflow from the subarachnoid space, often due to basal cistern or arachnoid granulation blockage.
  • Causes include subarachnoid hemorrhage, meningitis, and neoplastic or inflammatory exudates leading to subarachnoid space fibrosis or occlusion.
  • Early reports suggested excellent outcomes for CSF shunting procedures, leading to widespread application.

Observation:

  • Predictors of successful shunt surgery in EVOH typically include a specific clinical triad, identified etiology, gait disorder, short illness duration, normal CCT scans, and positive response to high-volume lumbar puncture.
  • This case highlights a favorable outcome with shunt surgery in idiopathic EVOH, despite a long disease duration and lack of improvement after lumbar puncture.

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Findings:

  • Shunt surgery can be effective in idiopathic EVOH cases previously considered poor candidates.
  • Favorable outcomes were observed even without typical predictive factors like short illness duration or response to lumbar puncture.

Implications:

  • Shunt surgery should be considered for clinically progressive idiopathic EVOH, even with a high complication rate, given limited therapeutic alternatives.
  • This finding expands the potential indications for shunt surgery in managing complex hydrocephalus cases.