Abstract
Background Vertebrobasilar dolichoectasia (VBDE) is defined as a symptomatic dilatation and
tortuosity of the vertebrobasilar arteries. The risk of hydrocephalus development
is due to direct compression of the third ventricle outflow or brainstem compression
and related aqueduct stenosis. We present an uncommon case of a patient with symptomatic
VBDE with the uniqueness of a hypoplastic third ventricle associated with biventricular
hydrocephalus. A literature review concerning diagnosis and management of patients
affected by biventricular hydrocephalus caused by VBDE was also performed.
Case Illustration We report a case of a 54-year-old man who presented with headache, ideomotor apraxia,
and gait disorder. A head computed tomography (CT) scan showed a biventricular hydrocephalus
and a subsequent CT angiography documented the presence of a VBDE compressing the
anterior part of the third ventricle that also appeared hypoplastic. The patient also
presented a clinical history of arterial hypertension for which he was given a proper
pharmacologic treatment with symptom relief. A surgical treatment of ventriculoperitoneal
shunt along with endoscopic septostomy was proposed, but the patient refused, probably
due to the slightly positive response to medical treatment.
Conclusions The natural clinical history of patients affected by VBDE is unfavorable with 7.8
years of median survival. The therapeutic strategy is usually conservative and the
role of antiplatelets or oral anticoagulants is still debated. In selected patients,
ventriculoperitoneal shunt to resolve intracranial hypertension caused by biventricular
hydrocephalus is the most effective treatment. In our opinion, chronic third ventricle
compression could lead to anatomic–pathologic alterations like the third ventricle
hypoplasia documented in our report.
Keywords
hydrocephalus - biventricular - vertebrobasilar artery - dolichoectasia - third ventricle
