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Neuroendoscopic third ventriculostomy in a patient with occluded foramen of Monro: a case report
T Inamura1, H Muratani, S Ogami
1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Japan. inamura@circus.ocn.ne.jp
Abstract:
We treated recurrent hydrocephalus in a previously shunted patient by neuroendoscopic third ventriculostomy. A tear was noted in the septum pellucidum. As the foramen of Monro was found to be occluded, we first fenestrated the floor of the lateral ventricle and then performed third ventriculostomy through the fenestration. A tough membrane believed to be Liliequist's membrane isolated the space immediately beneath floor of the third ventricle from the cistern below. Cerebrospinal fluid pulsation appeared after fenestration of this membrane. These obstructions presumably resulted from congenital and/or inflammatory causes. In cases such as this, successful neuroendoscopic third ventriculostomy presents a challenge to surgical judgment.
Insights
Neuroendoscopic third ventriculostomy successfully treated recurrent hydrocephalus in a shunted patient. Fenestrating Liliequist
Area of Science:
- Neurosurgery
- Neuroendoscopy
- Hydrocephalus Management
Background:
- Recurrent hydrocephalus in previously shunted patients poses significant treatment challenges.
- Obstructions in cerebrospinal fluid pathways, such as an occluded foramen of Monro and Liliequist's membrane, can impede flow.
- Congenital or inflammatory causes may contribute to these complex obstructions.
Observation:
- A tear in the septum pellucidum and an occluded foramen of Monro were identified in a patient with recurrent hydrocephalus.
- A tough membrane, presumed to be Liliequist's membrane, obstructed cerebrospinal fluid (CSF) flow beneath the third ventricle floor.
Findings:
- Successful NETV was achieved by fenestrating the lateral ventricle floor and then the obstructing membrane.
- Cerebrospinal fluid pulsation was restored after fenestrating Liliequist's membrane, indicating successful CSF diversion.
Implications:
- This case highlights the technical challenges and successful application of NETV in complex hydrocephalus cases.
- NETV can be a viable alternative to shunting in select patients with recurrent hydrocephalus due to anatomical obstructions.
- Congenital or inflammatory causes may lead to such complex obstructions requiring advanced neuroendoscopic techniques.
