Prenatal dispositions and genetic analysis of monozygotic female twins with suprasellar cysts and hydrocephalus: A case report

TL;DR

This case report describes identical twin girls with similar brain cysts and hydrocephalus, with no genetic cause found and a possible surgical treatment approach.

Contribution

The report highlights a rare case of monozygotic twins with suprasellar cysts and hydrocephalus, emphasizing the lack of genetic findings and surgical management.

Findings

Extensive genetic analyses found no pathogenic variants in the twins.

Prenatal exposure to anti-epileptic medication was not considered the cause of CNS malformations in the twins.

Surgical management included ventriculoperitoneal shunt placement and fenestration, with postoperative cyst reduction observed.

Abstract

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.

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.

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.

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