Disclosures: Karen N. Woods, MD: No financial relationships or conflicts of interest

Case Description: The patient was diagnosed with obstructive hydrocephalus secondary to aqueductal stenosis at age 17. He underwent aqueductoplasty at age 50 due to worsening unsteady gait, urinary incontinence, and mild confusion. Postoperative course was complicated by acute bilateral paralytic ptosis and worsening hydrocephalus. On admission to inpatient rehabilitation, the patient demonstrated complete bilateral paralytic ptosis, extraocular motility limitation, and severe extremity ataxia. Given his debilitating and persistently enlarged ventricles on MRI, a ventriculoperitoneal shunt was then placed to divert CSF with goal to improve symptoms.

Setting: Academic tertiary medical center

Patient: 50 year-old male with acute complete bilateral paralytic ptosis after aqueductoplasty for obstructive hydrocephalus Assessment/

Results: At 2 weeks postop, the patient showed mild improvement in bilateral paralytic ptosis with stable EOM limitations. He continued to require alternate taping of eyelids for meals and therapy in order to avoid exposure keratopathy and corneal abrasion and binocular diplopia. Oculoplastics procedure for bilateral frontalis suspensions will be considered in the future if deficits are stable with monitoring to maximize the patient’s function and independence. Further developments will be discussed.

Discussion: A unique and debilitating complication with aqueductoplasty and stenting is injury to upper brainstem structures resulting in diplopia, ptosis, and oculomotor paresis. This patient’s ptosis and EOM limitations are suspected to be secondary to ongoing compression from his stent versus surgical manipulation during initial placement for hydrocephalus management.

Conclusion: There are multiple complications from hydrocephalus and corresponding treatment interventions. We’ll review systematic guidelines for appropriate hydrocephalus management, interventions, and provide evidence based practice treatment guidelines.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/aqueductoplasty-complications-and-outcome-guideline-review-for-hydrocephalus-management/