title: Endoscopic third ventriculostomy for hydrocephalus due to unruptured pineal AVM: case report and review of the literature.
abstract: BACKGROUND
  Arteriovenous malformations (AVM) are considered to be static congenital lesions; however, a subset may possess dynamic pathophysiological capabilities of growth, regression or other morphological changes with time. We report on an adult patient harboring a pineal AVM who presented with progressive symptoms of obstructive hydrocephalus and was successfully treated by endoscopic third ventriculostomy (ETV).
  
  
  METHODS
  This 63-year-old man was incidentally diagnosed 8 years previously with an asymptomatic unruptured pineal AVM and followed conservatively until he developed a progressive impairment in consciousness with gait apraxia and incontinence over a period of 2 months. Magnetic resonance imaging (MRI) revealed obstructive hydrocephalus due to nidal compression at the level of the aqueduct. Treatment by ETV resulted in resolution of neurological deficits and ventriculomegaly without evidence of complications at 18-months follow-up.
  
  
  CONCLUSIONS
  Treatment by ETV in adults with obstructive hydrocephalus due to deep pineal AVMs is a reasonable option in selected cases. A discussion of the pathological mechanisms and therapeutic options for this rare entity is presented.
authors: Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
authors: Adam
authors: A
authors: Tucker
authors: Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
authors: Yoji
authors: Y
authors: Tamura
authors: Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
authors: Kenichiro
authors: K
authors: Hanabusa
authors: Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
authors: Hiroji
authors: H
authors: Miyake
authors: Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
authors: Masao
authors: M
authors: Tsuji
authors: Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
authors: Tohru
authors: T
authors: Ukita
authors: Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
authors: Takehisa
authors: T
authors: Ohmura
mesh_terms: D001072:Apraxias / Q000209:etiology / Q000473:pathology; D002535:Cerebral Aqueduct / Q000473:pathology; D005242:Fecal Incontinence / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D044583:Neuroendoscopy; D010870:Pineal Gland / Q000473:pathology*; D020542:Third Ventricle / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy / Q000379:methods*