{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:26:37Z","timestamp":1769729197331,"version":"3.49.0"},"reference-count":74,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T00:00:00Z","timestamp":1725840000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,9,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Parkinsonism has been reported in patients with obstructive hydrocephalus (OH) following ventriculoperitoneal shunting (VPS). While levodopa works well, some cases are drug resistant. A few case series have reported that endoscopic third ventriculostomy (ETV) is beneficial, though its mechanism remains unclear. The use of a pathophysiology-reflected marker can aid in the diagnosis and treatment strategy. The authors report a case of parkinsonism due to OH after VPS that improved after ETV in a patient taking levodopa, which was subsequently discontinued.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 52-year-old man who had undergone VPS for OH caused by aqueductal stenosis with a tectal tumor presented with severe consciousness disturbance due to acute hydrocephalus and levodopa-refractory parkinsonism after multiple episodes of shunt malfunction. Magnetic resonance imaging showed an elevation of the floor of the third ventricle. ETV was performed to stabilize the pressure imbalance across the stenosis, and his parkinsonism symptoms improved after long-term rehabilitation, resulting in levodopa discontinuation. His pontomesencephalic angle, the angle between the anterior surface of the midbrain and upper surface of the pons in the midline of the sagittal plane, was significantly decreased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The focus in such cases should be on the essence of the pathophysiology for improving the symptoms rather than on easy-to-understand indicators such as ventricle size.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2429\">https:\/\/thejns.org\/doi\/10.3171\/CASE2429<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2429","type":"journal-article","created":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T03:28:57Z","timestamp":1725852537000},"source":"Crossref","is-referenced-by-count":0,"title":["Levodopa-resistant parkinsonism developing after ventriculoperitoneal shunting for obstructive hydrocephalus and improving after endoscopic third ventriculostomy, with specific consideration of brainstem morphology: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Yoshihiko","family":"Morisue","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin-ichiro","family":"Osawa","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuniyasu","family":"Niizuma","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan"},{"name":"Departments of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigenori","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyoko","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidenori","family":"Endo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"BMC Neurol","first-page":"38","article-title":"Parkinsonism after ventriculoperitoneal shunt for hydrocephalus","volume":"23","author":"Zhang","year":"2023","unstructured":"Zhang YChen BWMao WWu FYZhang Y. Parkinsonism after ventriculoperitoneal shunt for hydrocephalus. BMC Neurol. 2023;23(1):38."},{"key":"bib2","series-title":"J Neurol Sci","first-page":"120019","article-title":"Parkinsonism and cerebrospinal fluid disorders","volume":"433","author":"Youn","year":"2022","unstructured":"Youn JTodisco MZappia MPacchetti CFasano A. Parkinsonism and cerebrospinal fluid disorders. J Neurol Sci. 2022;433:120019."},{"issue":"16","key":"bib3","series-title":"Mov Disord","first-page":"2438","article-title":"Subacute dopa-responsive parkinsonism after successful surgical treatment of aqueductal stenosis","volume":"24","author":"Kinugawa","year":"2009","unstructured":"Kinugawa KItti ELepeintre JF, et al. Subacute dopa-responsive parkinsonism after successful surgical treatment of aqueductal stenosis. 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Parkinsonism improved with levodopa after endoscopic third ventriculostomy in shunted hydrocephalus due to aqueductal stenosis. Neurologist. 2015;20(1):4-7."},{"issue":"10","key":"bib6","series-title":"J Neurol","first-page":"2141","article-title":"Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study","volume":"264","author":"Molde","year":"2017","unstructured":"Molde KS\u00f6derstr\u00f6m LLaurell K. Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study. J Neurol. 2017;264(10):2141-2148."},{"issue":"1","key":"bib7","series-title":"Mov Disord","first-page":"53","article-title":"Movement disorders in adult hydrocephalus","volume":"12","author":"Krauss","year":"1997","unstructured":"Krauss JKRegel JPDroste DWOrszagh MBorremans JJVach W. Movement disorders in adult hydrocephalus. 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J Neurol Neurosurg Psychiatry. 2004;75(11):1617-1619."},{"issue":"5","key":"bib26","series-title":"Brain Nerve","first-page":"527","article-title":"Rapidly progressive parkinsonism that developed one year after ventriculoperitoneal shunting for idiopathic aqueductal stenosis: a case report","volume":"62","author":"Sakurai","year":"2010","unstructured":"Sakurai TKimura AYamada M, et al. Rapidly progressive parkinsonism that developed one year after ventriculoperitoneal shunting for idiopathic aqueductal stenosis: a case report. Brain Nerve. 2010;62(5):527-531."},{"issue":"5","key":"bib27","series-title":"Clin Neurol Neurosurg","first-page":"423","article-title":"Acute parkinsonian syndrome after ventriculoperitoneal shunt malfunction caused by a roller coaster ride","volume":"113","author":"Lau","year":"2011","unstructured":"Lau CIWang HCTsai MD, et al. Acute parkinsonian syndrome after ventriculoperitoneal shunt malfunction caused by a roller coaster ride. 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