Pathogenesis of hydrocephalus in achondroplastic dwarfs: a review and presentation of a case followed for 22 years

Publication Date

2019

Journal Title

Childs Nerv Syst

Abstract

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Object: The purpose of this work is to review the pathogenesis and pathophysiology of hydrocephalus in patients with achondroplasia as a guide to its management throughout life. Methods: A review of the literature related to neurosurgical issues in achondroplasia with specific focus on cerebrospinal fluid physics, clinical management, and outcome of affected individuals. Issues involved in this review are highlighted by a case report of a patient shunted for achondroplasia first shunted in infancy and followed for 22 years. Each of the management issues is explored with respect to this patient. Findings: Head circumferences in achondroplasia are abnormally large in this condition usually caused by excess cerebrospinal fluid in the cortical subarachnoid space. Increase in ventricular size (hydrocephalus) is not rare but should not be treated unless rapidly progressive or symptomatic. The underlying cause of the abnormalities of cerebrospinal fluid dynamics relates to abnormal venous drainage at the skull base. Patients shunted in infancy for hydrocephalus usually remain dependent on the shunt for life, and crises of high intracranial pressure may occur with no distention of the ventricles. Conclusions: In infants with achondroplasia, large heads and enlarged ventricles without symptoms should be watched initially for progression. If hydrocephalus progresses or if symptoms of intracranial hypertension occur, endoscopic third ventriculostomy can be tried. If shunt is necessary, it should have a high opening pressure and a device to retard siphoning. In the case of recurrent ventricular catheter blockage, it may be necessary to create a communication between the ventricles and the cortical subarachnoid space.

Volume Number

35

Issue Number

8

Pages

1295 - 1301

Document Type

Article

Status

Faculty

Facility

School of Medicine

Primary Department

Neurosurgery

PMID

31227857

DOI

10.1007/s00381-019-04227-8

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