SUN-076 - Late-Onset Surgery-Induced Hydrocephalus

Introduction: Late-onset surgery-induced hydrocephalus is a rare complication that can develop months or even years after a surgical procedure. The causes of hydrocephalus are typically classified into two categories: those related to blockage and those related to cerebrospinal fluid (CSF) absorption. Obstructive hydrocephalus occurs when blood, tissue, or inflammation blocks the aqueduct or CSF outlets. Conversely, impaired absorption, known as communicating hydrocephalus, happens when blood or inflammation damages the arachnoid granulations, reducing CSF absorption into the bloodstream.
The most common sign of hydrocephalus is cognitive decline, which appears as decreased attention, confusion, memory issues, apathy, and slowed thinking. Other signs include urinary urgency or incontinence, headache, blurred or double vision, dizziness, and gait problems.
Clinical Presentation: A 16-year-old female with a low-grade astrocytoma in the pituitary hypothalamic region underwent open craniotomy. Her initial recovery was uneventful, and she experienced no hormonal deficiencies. Later in life, she held a full-time job and performed her duties effectively. Seven years after her surgery, she developed chronic headaches with no other symptoms. Her neurologist, who monitored her for the following eight years, treated her headaches with medication and periodically performed brain CT scans to check for tumor recurrence. She was reassured that her headaches were not related to her previous surgery. She developed galactorrhea due to elevated prolactin and was referred to an endocrinologist, who prescribed cabergoline. Her prolactin levels returned to normal, but her headaches persisted. Due to her ongoing headaches, her previous CT scan reports were reviewed, and it was found that radiology had never reported any signs of hydrocephalus. I then asked her to bring her actual films, which revealed subtle signs of mildly narrowed and effaced cortical sulci, without ventriculomegaly, consistent with early signs of hydrocephalus.
The neurosurgeon agreed and placed a ventricular-peritoneal shunt. At her follow-up appointment, she reported being headache-free for the first time in eight years and has remained headache-free for ten years since the procedure.
Learning Points:
1. Symptoms of late-onset surgery-induced hydrocephalus have been reported as long as 36 years afterward.
2. Even if experts previously dismissed mild signs of hydrocephalus, any renewed suspicion of the diagnosis should be carefully reviewed and thoroughly investigated.
Reference
Kalkanis SN, et al. Delayed complications thirty-six years after hemispherectomy: a case report. Epilepsia. 37(8):758-62 (1996).
Yukinori T, et al. Hydrocephalus Resulting from Late-Onset Aqueductal Membranous Occlusion: A Case Report and Review of the Literature. World Neurosurgery, 137, 345-49 (2020).

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*