J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e45-e49
DOI: 10.1055/s-0032-1330120
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Third Ventriculostomy for Hydrocephalus Due to Unruptured Pineal AVM: Case Report and Review of the Literature

Adam Tucker
1   Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
,
Yoji Tamura
2   Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
,
Kenichiro Hanabusa
1   Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
,
Hiroji Miyake
1   Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
,
Masao Tsuji
1   Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
,
Tohru Ukita
1   Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
,
Takehisa Ohmura
1   Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
› Author Affiliations
Further Information

Publication History

23 August 2011

02 March 2012

Publication Date:
20 February 2013 (online)

Abstract

Introduction 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).

Clinical presentation 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.

Conclusion 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.

 
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