Acute decompensation of noncommunicating hydrocephalus caused by dilated Virchow-Robin spaces type III in a woman treated by endoscopic third ventriculostomy: a case report and review of the literature.
BACKGROUND
Even though dilated Virchow-Robin spaces (VRS) are a very rare entity, they can compel the clinician to start immediate intervention in the case of acute onset of symptoms. To allow a well-balanced management decision, we compiled a summary of all cases published in the literature and discuss the different methods and indications for neurosurgical intervention in relation to dilated VRS.


METHODS
We report a case of a 43-year-old female patient who came to admission after syncope with a history of unspecific neck pain, fatigue, diplopia, and dizziness. Dilated VRS type III causing a noncommunicating hydrocephalus were found to be responsible. Although the patient was initially awake, within 72 hours after admission, a deterioration of consciousness and repeated vomiting were observed. The patient underwent an urgent endoscopic third ventriculostomy (ETV) and was discharged in a good condition.


CONCLUSIONS
To the best of our knowledge, the case presented here is the first case of acute decompensation of a noncommunicating hydrocephalus caused by dilated VRS. Neurosurgical intervention is required in cases of noncommunicating hydrocephalus caused by giant tumefactive VRS. The treatment options are mono- or biventricular shunt surgery or ETV. Because ETV provides the possibility of cyst fenestration and membrane sampling, it appears to be the most advantageous treatment option.
Clinic for Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
Malte
M
Ottenhausen
Clinic for Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
Ullrich
U
Meier
Institute for Radiology, Unfallkrankenhaus Berlin, Berlin, Germany.
Anja
A
Tittel
Clinic for Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
Johannes
J
Lemcke
D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009460:Neurologic Examination; D013575:Syncope / Q000209:etiology; D020542:Third Ventricle / Q000601:surgery*; D014474:Unconsciousness / Q000209:etiology; D014696:Ventriculostomy / Q000379:methods*; D014839:Vomiting / Q000209:etiology