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Child's Nervous System

, Volume 35, Issue 8, pp 1295–1301 | Cite as

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

  • Harold L. Rekate
Review Article

Abstract

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.

Keywords

Hydrocephalus Achondroplastic dwarfs Endoscopic third ventriculostomy Slit ventricle syndrome 

Notes

Compliance with ethical standards

Conflict of interest

I the author of this review attest that I have no conflicts of interest related to any aspect of the paper.

Harold L. Rekate

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Donald and Barbara Zucker Hofstra Northwell School of MedicineHempsteadUSA
  2. 2.NeurosurgeryDonald and Barbara Zucker Hofstra Northwell School of MedicineHempsteadUSA

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