title: Cervical myelopathy due to chronic overshunting in a pediatric patient: case report and review of the literature.
abstract: We present a rare cause of cervical myelopathy produced by an engorged suboccipital epidural venous plexus due to chronic cerebrospinal fluid (CSF) overdrainage. A 17-year-old boy with obstructive hydrocephalus due to a retrocerebellar cyst and secondary implantation of a ventricloperitoneal shunt (VP-shunt) presented with progressive spastic tetraparesis. MRI imaging revealed myelopathy due to significant compression of the cervical spinal cord by engorged epidural veins. Further assessment at a low-pressure setting revealed a broken shunt valve. The VP-shunt valve was changed with an additional anti-siphon device leading to a gradual increase of the intracranial pressure (ICP). After intensive physiotherapy, the patient showed slight clinical improvement. Follow-up imaging within nine days showed distinct regression of the dilated venous plexus at the cranial-cervical junction (CCJ) with the resolution of cord compression. Engorgement of the epidural venous plexus should always be considered in the differential diagnosis of myelopathy in long-term shunt patients even when classical clinical and radiological signs of overshunting are missing.
authors.affiliation: University Hospital of Zurich, Department of Neurosurgery, Zurich, Switzerland. nils.ulrich@usz.ch
authors.forename: Nils Harry-Bert
authors.initials: NH
authors.lastname: Ulrich
authors.forename: Matthias
authors.initials: M
authors.lastname: Maier
authors.forename: Rene-Ludwig
authors.initials: RL
authors.lastname: Bernays
authors.forename: Niklaus
authors.initials: N
authors.lastname: Krayenbuhl
authors.forename: Spyros
authors.initials: S
authors.lastname: Kollias
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000601:surgery; D002908:Chronic Disease; D004824:Epidural Space / Q000098:blood supply; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D013116:Spinal Cord / Q000098:blood supply / Q000601:surgery; D013117:Spinal Cord Compression / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*