Bilateral Chronic Subdural Haematoma After Endoscopic Third Ventriculostomy: Case Report and Review of the Literature

摘要

Several complications related to Endoscopic third ventriculostomy (ETV) have beenreported in the literature including chronic subdural haematoma. This is usuallyunilateral. We report a case of a 12-month-old female child with bilateral chronicsubdural haematoma (CSH) 3months after an ETV. She had a ventriculoperitoneal shunt at 5months of age on account of congenital aqueductal stenosis with marked cerebral mantle thining. At 9months of age an ETV was done due to shunt obstruction. The CSH was successfully treated by burr-hole evacuation on both sides. Though ETV is a simple, effective and safe procedure, and also the main stay of treatment for noncommunicating hydrocephalus in many centres, long term follow up should still be emphasised. Introduction Endoscopic third ventriculostomy (ETV) is generally believed to be a safe procedure and is now the treatment of choice for noncommunicating hydrocephalus. It is associated with fewer complications than extracranial cerebrospinal fluid diversion 1. Possible complications associated with ETV are cerebrospinal fluid leak, meningitis, ventriculitis, postoperative memory deficit, hypothalamic dysfunction, hemiparesis, midbrain damage, subarachnoid haemorrhage, and arrhythmia with cardiac arrest. Subdural effusion or haematoma is not considered less frequent after ETV, but only a few cases occurring bilaterally have been reported2. We report a case of bilateral chronic massive subdural haematoma that developed after ETV. The clinical and radiological findings in this case are discussed. Possible mechanisms for this clinical occurrence are also discussed. Case report N. O. is a 12-month-old female child who presented with worsening restlessness and persistent vomiting of two weeks duration. Two days prior to presentation she became difficult to arouse. There was no antecedent history of child abuse, head trauma or fever. She was diagnosed with congenital aqueductal stenosis for which she had a ventriculoperitoneal shunt at 5months of age (Figure 1). This failed from proximal shunt obstruction. This was treated by ETV at 9months of age. The ETV was uneventful. Physical examination revealed a 12.5-kg girl who was drowsy, lethargic, afebrile and not pale. She had bilateral dilated pupils which reacted sluggishly to light, bilateral papilloedema, and bilateral abducent nerve palsy. There was no retina haemorrhage. Muscle stretch reflexes were increased globally.