The clinical spectrum and management outcome of adult-onset aqueductal stenosis: Insight from South-West Nigeria.

Background: Adult-onset aqueductal stenosis (AOAS) is an uncommon cause of hydrocephalus in adults. Its etiopathogenesis is poorly understood, with various proposed mechanisms, spectrum of presentation, and management. Very little has been reported on this anomaly in African literature. This study aimed to describe the pattern of presentation, clinical spectrum, and early outcomes following the shunt procedure in our population practice setting.

Methods: This was a retrospective case series of patients with non-tumoral AOAS managed between 2008 and 2023 in a tertiary center in South-West Nigeria. Relevant demographic, clinical-radiologic, and outcome data were retrieved and analyzed.

Results: There were seven males and one female. Their age ranged from 18 to 50 years. The duration of symptoms ranged from 3 to 120 months. All patients admitted having headaches; however, visual deterioration (n = 5) was the most common presenting symptom. Features of endocrinopathy (n = 1), cerebellar dysfunction (n = 2), cognitive deficit (n = 2), spontaneous cerebrospinal fluid leak (n = 1), and sphincteric dysfunction (n = 1) were also observed. The mean Evan's index at the presentation was 0.43. Ventriculoperitoneal shunt (VPS) insertion was performed in seven patients with good outcomes. One patient opted for a referral. One patient had shunt revision 6 years later on account of shunt disconnection.

Conclusion: AOAS is an infrequent cause of hydrocephalus in our setting, with most patients seeking medical consultation following visual deterioration. Proper evaluation of adults with long-standing headaches and associated features is advocated to avert total visual loss in this subgroup. VPS insertion is a viable treatment option with a good outcome.