TY - JOUR

T1 - Prenatal dispositions and genetic analysis of monozygotic female twins with suprasellar cysts and hydrocephalus

T2 - A case report

AU - Guldberg, Frederikke

AU - Larsen, Carl Christian

AU - Østergaard, Elsebet

AU - Carlsen, Jonathan

AU - Juhler, Marianne

AU - Munch, Tina Nørgaard

N1 - Publisher Copyright: © The Author(s) 2023.

PY - 2024

Y1 - 2024

N2 - Introduction: We present a unique case of monozygotic female twins with virtually identical clinical and radiological presentations of supratentorial hydrocephalus and cystic formations from the suprasellar cistern. Discussion: Evaluating genetic predispositions and prenatal exposures is crucial for hydrocephalus in twins. Familial cases imply a genetic contribution to the development of these anomalies, including chromosomal abnormalities and specific variants linked to arachnoid cyst formation in various syndromes. Extensive genetic analyses found no pathogenic variants in the twins. Prenatal exposure to anti-epileptic medication was known during pregnancy and may be associated with fetal abnormalities, but not central nervous system (CNS) malformations, and was therefore not considered the cause of the condition in the twins. The twins presenting simultaneously with hydrocephalus caused by suprasellar cysts (SAC) underwent a two-step surgical management: initial ventriculoperitoneal shunt (VPS) placement followed by fenestration. Postoperative imaging showed cyst reduction, but a secondary VPS was necessary in both cases. Conclusion: Genetic analysis is less likely to identify a monogenic etiology in non-syndromic cases of SACs, which are assumed to be multifactorial. There is no established evidence linking a teratogenic effect of anti-epileptic drugs to CNS malformations. Moreover, the surgical treatment of this complex condition constitutes a point of discussion.

AB - Introduction: We present a unique case of monozygotic female twins with virtually identical clinical and radiological presentations of supratentorial hydrocephalus and cystic formations from the suprasellar cistern. Discussion: Evaluating genetic predispositions and prenatal exposures is crucial for hydrocephalus in twins. Familial cases imply a genetic contribution to the development of these anomalies, including chromosomal abnormalities and specific variants linked to arachnoid cyst formation in various syndromes. Extensive genetic analyses found no pathogenic variants in the twins. Prenatal exposure to anti-epileptic medication was known during pregnancy and may be associated with fetal abnormalities, but not central nervous system (CNS) malformations, and was therefore not considered the cause of the condition in the twins. The twins presenting simultaneously with hydrocephalus caused by suprasellar cysts (SAC) underwent a two-step surgical management: initial ventriculoperitoneal shunt (VPS) placement followed by fenestration. Postoperative imaging showed cyst reduction, but a secondary VPS was necessary in both cases. Conclusion: Genetic analysis is less likely to identify a monogenic etiology in non-syndromic cases of SACs, which are assumed to be multifactorial. There is no established evidence linking a teratogenic effect of anti-epileptic drugs to CNS malformations. Moreover, the surgical treatment of this complex condition constitutes a point of discussion.

KW - Endoscopic fenestration

KW - Obstructive hydrocephalus

KW - Prenatal dispositions

KW - Suprasellar cyst

KW - Twins

U2 - 10.1007/s00381-023-06245-z

DO - 10.1007/s00381-023-06245-z

M3 - Journal article

C2 - 38052889

AN - SCOPUS:85178395164

VL - 40

SP - 947

EP - 951

JO - Child's Nervous System

JF - Child's Nervous System

SN - 0256-7040

IS - 3

ER -