title: Acute triventricular hydrocephalus caused by choroid plexus cysts: a diagnostic and neurosurgical challenge.
abstract: OBJECTIVE Intraventricular choroid plexus cysts are unusual causes of acute hydrocephalus in children. Radiological diagnosis of intraventricular choroid plexus cysts is difficult because they have very thin walls and fluid contents similar to CSF and can go undetected on routine CT studies. METHODS This study reports the authors' experience with 5 patients affected by intraventricular cysts originating from the choroid plexus. All patients experienced acute presentation with rapid neurological deterioration, sometimes associated with hypothalamic dysfunction, and required urgent surgery. In 2 cases the symptoms were intermittent, with spontaneous remission and sudden clinical deteriorations, reflecting an intermittent obstruction of the CSF pathway. RESULTS Radiological diagnosis was difficult in these cases because a nonenhanced CT scan revealed only triventricular hydrocephalus, with slight lateral ventricle asymmetry in all cases. MRI with driven-equilibrium sequences and CT ventriculography (in 1 case) allowed the authors to accurately diagnose the intraventricular cysts that typically occupied the posterior part of the third ventricle, occluding the aqueduct and at least 1 foramen of Monro. The patients were managed by urgent implantation of an external ventricular drain in 1 case (followed by endoscopic surgery, after completing a diagnostic workup) and by urgent endoscopic surgery in 4 cases. Endoscopic surgery allowed the shrinkage and near-complete removal of the cysts in all cases. Use of neuronavigation and a laser were indispensable. All procedures were uneventful, resulting in restoration of normal neurological conditions. Long-term follow-up (> 2 years) was available for 2 patients, and no complications or recurrences occurred. CONCLUSIONS This case series emphasizes the necessity of an accurate and precise identification of the possible causes of triventricular hydrocephalus. Endoscopic surgery can be considered the ideal treatment of choroid plexus cysts in children.
authors: Departments of 1 Paediatric Neurosurgery and.
authors: Pietro
authors: P
authors: Spennato
authors: Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, School of Medicine and Surgery "Federico II," Naples; and.
authors: Carmela
authors: C
authors: Chiaramonte
authors: Neuroradiology, and.
authors: Domenico
authors: D
authors: Cicala
authors: Pathology Unit, Santobono-Pausilipon Children's Hospital.
authors: Vittoria
authors: V
authors: Donofrio
authors: Department of Neurosurgery, Second University of Naples, Italy.
authors: Manlio
authors: M
authors: Barbarisi
authors: Neuroradiology, and.
authors: Anna
authors: A
authors: Nastro
authors: Departments of 1 Paediatric Neurosurgery and.
authors: Giuseppe
authors: G
authors: Mirone
authors: Departments of 1 Paediatric Neurosurgery and.
authors: Vincenzo
authors: V
authors: Trischitta
authors: Departments of 1 Paediatric Neurosurgery and.
authors: Giuseppe
authors: G
authors: Cinalli
mesh_terms: D000208:Acute Disease; D020863:Central Nervous System Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002831:Choroid Plexus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007223:Infant; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: DRIVE = driven-equilibrium; EMA = epithelial membrane antigen; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; GFAP = glial fibrillary acidic protein; SSFP = steady-state free precession; TSE = turbo spin echo; WBC = white blood cell; WISC-R = Wechsler Intelligence Scale for Children–revised; b-FFE = balanced-fast field echo; neuroendoscopy; neuroepithelial cyst; triventricular hydrocephalus; ventriculostomy