- Department of Spinal Surgery, Kameda Medical Center, Kamogawa-Shi, Chiba, Japan.
DOI:10.25259/SNI_851_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Isamu Miura, Motoo Kubota, Nobuhiko Momozaki, Masahito Yuzurihara. Two cases of normal pressure hydrocephalus caused by ependymoma of the cauda equina. 05-Jan-2021;12:8
How to cite this URL: Isamu Miura, Motoo Kubota, Nobuhiko Momozaki, Masahito Yuzurihara. Two cases of normal pressure hydrocephalus caused by ependymoma of the cauda equina. 05-Jan-2021;12:8. Available from: https://surgicalneurologyint.com/surgicalint-articles/10507/
Background: Normal pressure hydrocephalus (NPH) associated with tumors of the cauda equina is rare. Here, we report two cases of NPH attributed to cauda equina ependymomas.
Case Description: A 63-year-old male presented with progressive gait disturbance, dementia, and urinary incontinence. When the lumbar MR documented an intradural tumor involving the cauda equina at the L2-L3 level; the tumor was excised; pathologically, it proved to be a myxopapillary ependymoma. Postoperatively, however, the patient’s continued gait disturbance led to a brain CT that documented ventricular dilation consistent with NPH; following ventriculoperitoneal (VP) shunt placement his symptoms improved. A 65-year-old female also presented with gait disturbance, dementia, and urinary retention. Here, procedures were performed in reverse. When a brain CT showed hydrocephalus, a VP shunt was placed. When symptoms persisted, a lumbar MR demonstrated a T12-L2 intradural tumor; following a lumbar laminectomy for tumor excision, symptoms stabilized. The pathological diagnosis was also consistent with a conus/cauda equina ependymoma. Over the next 10 years, the patient had residual bladder dysfunction (e.g., requiring straight catheterization), but had no shunt dysfunction.
Conclusion: We observed two cases of ependymomas of the cauda equina and brain CTs documenting NPH that was successfully surgically managed with stabilization of neurological deficit. In the first case, L2-L3 laminectomy for tumor removal was succeeded by shunting for NPH, while in the second case, initial VP shunting for NPH was followed by a T12-L2 laminectomy for tumor excision.
Keywords: Cauda equina, Ependymoma, Myxopapillary ependymoma, Normal pressure hydrocephalus, Spinal tumor
Normal pressure hydrocephalus (NPH) associated with tumors of the cauda equina is rare.[
A 63-year-old male developed right lower extremity weakness over a 6-month period associated with gait disturbance, dementia, and urinary incontinence. The lumbar MR demonstrated an intradural tumor at the L2-L3 level involving the cauda equina: the lesion was hypointense on T1 and hyperintense on T2-weighted images, but due to renal failure, no contrast was administered [
A 65-year-old female also presented with gait disturbance, dementia, and urinary retention; her neurological examination only revealed an ataxic gait. The brain CT demonstrated ventricular dilation consistent with NPH and a VP shunt was placed [
NPH associated with tumors of the cauda equina is rare.[
Here, we presented two cases of cauda equina ependymomas that contributed to increased intracranial pressure (e.g., consistent with NPH). The first patient required primary thoracolumbar/lumbar L2-L3 ependymoma tumor excision followed by secondary VP shunting, while in the second case, initial VP shunting was succeeded by T12-L2 laminectomy for tumor removal.
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