Esthesioneuroblastoma: Experience at the National Institute of Neurology and Neurosurgery

Internal carotid artery agenesis (ICAa) is a rare congenital vascular condition that can affect one or both sides. The association of ICAa and aqueductal stenosis have never been reported in the literature.

We report the case of a 9-year-old with a right ICAa and associated aqueductal stenosis with triventricular hydrocephalus solved by an endoscopic third ventriculostomy (ETV) and developed an early acute ischemic stroke in the postoperative evolution. We discuss the clinical presentation and evolution of the patient, imaging findings, indications of the ETV, and the review of the literature on the association of the ICAa and hydrocephalus.

The team calculated an ETV success score of 70 points (70%) based on her past medical history.  We did a right precoronal incision and an endoscopic visualization was done, after that, a third ventriculostomy with a balloon and a septostomy was done without incidents. In the postoperative period, the patient had recovered well, but 48 hrs later she developed a peripheral facial palsy grade II. We prescribed oral steroids. 72 hrs later she presented an episode of left hemiparesis with a 10-minute duration. An MRI non- enhanced study was performed with evidence of an early hyperacute ischemic stroke. On the fourth postoperative day, she developed a right abducens nerve palsy without diplopia, only limiting the abduction of the right eye movement. By the time of discharge, she had no headache, but facial and abducens palsy remains. Two weeks after discharge the patient had a full recovery without palsy of the facial and abducens cranial nerves.

This is the first clinical report of a patient with ICAa and ETV.

Author(s): Rafael Vazquez Gregorio

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