Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2001-08, Vol.71 (2), p.268-271
• Main Authors: Benabarre, A, Ibáñez, J, Boget, T, Obiols, J, Martínez-Aran, A, Vieta, E
• Format: Article
• Language: English
• Subjects: Adult; Binge eating; Biological and medical sciences; Brain Diseases - pathology; Brain Diseases - psychology; Brain Diseases - surgery; Case reports; Causes of; Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves; Complications and side effects; Endoscopy; Heart ventricles; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Medical sciences; neuroendoscopy; Neurologic manifestations of general diseases; neuropsychological complications; Neuropsychological Tests; Neuropsychology; Neurosurgery; Personality disorders; Personality Disorders - etiology; Personality Disorders - psychology; Psychomotor disorders; Short Report; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Syndrome; Third Ventricle - pathology; Third Ventricle - surgery; third ventriculostomy
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.71.2.268

The clinical case report of a patient who underwent an endoscopic third ventriculostomy for the treatment of a slit ventricle syndrome is presented. After surgery the patient developed a severe complication consisting of an organic personality disorder, characterised by impulsiveness, physical heteroaggressiveness, binge eating, hypersomnia and impairment of memory, and frontal-executive functions. A frontal lobe lesion may explain some of the symptoms presented, such as the uncontrolled impulses, the aggressive behaviour, and even the binge eating. However, a longitudinal neuropsychological evaluation showed a severe deficit in immediate memory and difficulties in planning and consolidation of newly learned information, which may be best related to damage in the frontal basal structures of the brain: the fornix and its connection to the hippocampus and the mamillary bodies. Postoperative MR images confirmed the clinical hypothesis. The emergence of such a severe organic personality disorder and cognitive disturbances as a psychiatric complication of an endoscopic third ventriculostomy has not, it seems, been previously reported elsewhere. Clinicians should take these possible complications into account when recommending this so-called minimally invasive neuroendoscopic procedure.