Aqueductal Stenosis Symptoms, Causes, Prognosis, Treatment

What is Aqueductal Stenosis?

The small cerebral aqueduct, which connects the third and fourth ventricles of the brain, can narrow or become blocked, leading to a disease known as aqueductal stenosis. This may result in an accumulation of cerebrospinal fluid (CSF) in the brain, which may result in hydrocephalus.

When a cerebrospinal fluid (CSF) builds up abnormally in the brain's ventricles, a disease known as hydrocephalus develops. This condition puts pressure on brain cells and can even lead to brain injury. Aqueductal stenosis is a prevalent cause of congenital hydrocephalus, which simply implies that the condition was there when the patient was born.

The most effective method of diagnosing aqueductal stenosis is MRI, particularly when a unique constructive interference in a steady-state sequence is employed. Multivariate analysis revealed that enlarged inferior third ventricular recesses, enlarged lateral ventricles and third ventricles, and an aberrant corpus callosum were the predominant features linked with a valid prenatal assessment of congenital aqueductal stenosis.

Sonography during pregnancy is the gold standard for diagnosing fetal aqueductal stenosis, and it can be confirmed by postnatal CT/MR scanning or sonography.

Symptoms

Aqueductal stenosis symptoms include headache, vomiting and nausea, cognitive problems, tiredness, convulsions, coordination and gait disturbances, vision abnormalities, and incontinence. These symptoms are analogous to those of hydrocephalus. Individuals who have aqueductal stenosis are more likely to suffer from "upward gaze palsy," which is difficulty seeing upward. The following symptoms are also frequent: headache, blurred vision, mental decline, and abnormal gait. Both adults and kids who have aqueductal stenosis have incontinence as a symptom.

Causes

There are numerous potential reasons for aqueductal stenosis, such as:

• Most occurrences of aqueductal stenosis occur at birth (congenital). Genetic anomalies or issues that arise during embryonic development could be the cause of the disease.
• In some instances, aqueductal stenosis may develop later in life. Often, this happens as a result of brain tissue damage, infection, or inflammation.
• Stenosis can be caused by tumors if the tumor presses on the surrounding tissue and prevents cerebrospinal fluid from flowing through the aqueduct. Tumors can occur in or around the aqueduct.
• An injury to the brain that results in bleeding, such as a stroke, can cause inflammation and scarring, which can narrow or obstruct the aqueduct.
• Aqueductal stenosis can be brought on by infections, which can infect the brain tissue and produce meningitis. These infections can also induce inflammation and scarring.
• Brain injuries caused by trauma can produce scarring or damage to brain tissue, both of which can contribute to aqueductal stenosis.
• The aqueduct may get scarred and constrict as a result of radiation treatment for brain tumors or other diseases.

Prognosis

Aqueductal stenosis prognosis is condition-specific and dependent on age at diagnosis. The prognosis is quite poor when aqueductal stenosis is diagnosed in utero, with a death rate of 40%. The endoscopic third ventriculostomy (ETV) procedure has an 80% success rate and is recommended for patients with aqueductal stenosis. Epilepsy was seen in 13% of cases of aqueductal stenosis identified in utero, although the long-term outlook of patients with this condition is uncertain.

Treatment

Depending on the condition's severity and the patient's age at diagnosis, aqueductal stenosis is treated differently. Nowadays, shunt surgery and ventriculostomy are the two alternative surgical procedures available to treat aqueductal stenosis. The preferred procedure is endoscopic third ventriculostomy (ETV), which has an 80% success rate in general. In individuals with hydrocephalus due to membranous aqueductal stenosis, endoscopic aqueductoplasty provides an alternative treatment option; however, the recurring rate is high. When it comes to fetal situations, ventriculoamniotic shunting can reduce or perhaps prevent permanent brain damage by relieving intracranial pressure in the developing fetus.