“Growing cerebellum” requiring operative decompression following perinatal ventriculoperitoneal shunting
Tóm tắt
While cases of acquired Chiari I malformation following ventriculoperitoneal shunting for posthemorrhagic hydrocephalus have been reported, true disproportionate cerebellar growth is rare, with no previous cases requiring posterior fossa decompression reported. We present a premature neonate who underwent ventriculoperitoneal shunt placement for suspected posthemorrhagic hydrocephalus. He subsequently developed a symptomatic Chiari I malformation with volumetric measurements demonstrating disproportionate growth of the cerebellum. He did not demonstrate thickening of the supratentorial or posterior fossa cranium. The patient underwent an extradural posterior fossa decompression, with resolution of symptoms. We review the extant literature regarding the development of Chiari malformation type I as a manifestation of craniocerebral disproportion (CCD) following shunt placement for posthemorrhagic hydrocephalus of prematurity. Most previous reports reflect a mechanism that includes underdevelopment of the intracranial posterior fossa (or supratentorial) volume. The case presented in this report, as well as one additional case, indicates that there may exist a variant mechanism, characterized by rapid growth of the cerebellum itself, in the absence of one of the rare syndromes associated with primary macrocerebellum. While this case was effectively managed with extradural posterior fossa decompression, previous reports indicate that supratentorial cranial expansion procedures are preferable in some cases. As such, pediatric neurosurgeons should be able to distinguish the patterns of craniocerebral disproportion when considering treatment options for these patients. Further investigation regarding these uncommon patients may better describe the underlying mechanisms.
Tài liệu tham khảo
Kazan S, Güra A, Uçar T et al (2005) Hydrocephalus after intraventricular hemorrhage in preterm and low–birth weight infants: analysis of associated risk factors for ventriculoperitoneal shunting. Surg Neurol 64:S77–S81. https://doi.org/10.1016/j.surneu.2005.07.035
Loop JW, Foltz EL (1972) Craniostenosis and diploic lamination following operation for hydrocephalus. Acta Radiol Diagn 13:8–13
Sandler AL, Goodrich JT, Daniels LB et al (2013) Craniocerebral disproportion: a topical review and proposal toward a new definition, diagnosis, and treatment protocol. Childs Nerv Syst 29:1997–2010. https://doi.org/10.1007/s00381-013-2257-7
Ryoo HG, Kim S-K, Cheon J-E et al (2014) Slit ventricle syndrome and early-onset secondary craniosynostosis in an infant. American Journal of Case Reports 15:246–253. https://doi.org/10.12659/AJCR.890590
Osuagwu FC, Lazareff JA, Rahman S, Bash S (2006) Chiari I anatomy after ventriculoperitoneal shunting: posterior fossa volumetric evaluation with MRI. Childs Nerv Syst 22:1451–1456. https://doi.org/10.1007/s00381-006-0118-3
Caldarelli M, Novegno F, Di Rocco C (2009) A late complication of CSF shunting: acquired Chiari I malformation. Childs Nerv Syst 25:443–452. https://doi.org/10.1007/s00381-008-0760-z
D’Arco F, Ugga L, Caranci F et al (2016) Isolated macrocerebellum: description of six cases and literature review. Quant Imaging Med Surg 6:496–503. https://doi.org/10.21037/qims.2016.06.10
Benvenisti H, Bassan H, Shiran S et al (2015) “Growing” cerebellum in an infant after shunt insertion. Pediatr Neurol 52:222–225. https://doi.org/10.1016/j.pediatrneurol.2014.10.003
Hoffman HJ, Tucker WS (1976) Cephalocranial disproportion: a complication of the treatment of hydrocephalus in children. Child’s Brain 2:167–176
Poretti A, Mall V, Smitka M et al (2012) Macrocerebellum: significance and pathogenic considerations. Cerebellum 11:1026–1036. https://doi.org/10.1007/s12311-012-0379-1
Torreman M, Smit L, van der Valk P, et al (1993) A case of macrocephaly, hydrocephalus, megacerebellum, white matter abnormalities and Rosenthal fibres. Dev Med Child Neurol 35:732–736
van der Knaap MS, Salomons GS, Li R, et al (2005) Unusual variants of alexander’s disease: atypical alexander’s disease. Ann Neurol 57:327–338. https://doi.org/10.1002/ana.20381
Gripp KW, Hopkins E, Doyle D, Dobyns WB (2010) High incidence of progressive postnatal cerebellar enlargement in Costello syndrome: brain overgrowth associated with HRAS mutations as the likely cause of structural brain and spinal cord abnormalities. Am J Med Genet A 152A:1161–1168. https://doi.org/10.1002/ajmg.a.33391
Schaefer GB, Bodensteiner JB, Buehler BA et al (1997) The neuroimaging findings in Sotos syndrome. Am J Med Genet 68:462–465. https://doi.org/10.1002/(SICI)1096-8628(19970211)68:4<462::AID-AJMG18>3.0.CO;2-Q
Di Rocco C, Velardi F (2003) Acquired Chiari type I malformation managed by supratentorial cranial enlargement. Childs Nerv Syst 19:800–807. https://doi.org/10.1007/s00381-003-0837-7