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Neuroendoscopic foraminal plasty of foramen of Monro
1Division of Pediatric Neurosurgery, The Jikei University Hospital, Women's and Children's Medical Center, Tokyo, Japan. shizuo.prof.oi@jikei.ac.jp
Objectives:
The aims of this study were to describe and analyze the technique of neuroendoscopic foraminal plasty of foramen of Monro (NEFPFMO) in the treatment of isolated unilateral hydrocephalus (IUH) due to membranous occlusion, to evaluate its efficacy and safety, and to define the benefits of neuronavigational guidance of the procedure.
Materials And Methods:
Two symptomatic neonates with IUH, as a result of congenital atresia of foramen of Monro, underwent NEFPFMO plus neuroendoscopic septostomy in the first case and neuronavigational guidance in the second one. Clinical results were excellent in both neonates. The postoperative ventricular size decreased and the progressive IUH changed to the state of arrested hydrocephalus. The neuronavigation was precise.
Conclusion:
NEFPFMO should be the primary treatment option in patients with IUH due to membranous occlusion of foramen of Monro. It reestablishes natural anatomical communication and provides real physiological cerebrospinal fluid flow. Neuronavigation is a useful adjunct of NEFPFMO.
Insights
Neuroendoscopic foraminal plasty of the foramen of Monro (NEFPFMO) effectively treats isolated unilateral hydrocephalus (IUH). This technique restores natural cerebrospinal fluid flow and is enhanced by neuronavigation.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Minimally Invasive Neurosurgery
Background:
- Isolated unilateral hydrocephalus (IUH) in neonates often results from congenital atresia of the foramen of Monro.
- Membranous occlusion of the foramen of Monro presents a significant challenge in pediatric neurosurgery.
- Traditional treatments may carry risks and limitations for this specific condition.
Observation:
- This study evaluated neuroendoscopic foraminal plasty of the foramen of Monro (NEFPFMO) in two neonates with IUH.
- One neonate underwent NEFPFMO with neuroendoscopic septostomy, while the second received NEFPFMO with neuronavigational guidance.
- Both neonates exhibited excellent clinical outcomes post-procedure.
Findings:
- NEFPFMO successfully reduced ventricular size and arrested hydrocephalus progression in both cases.
- The procedure effectively reestablished natural anatomical communication within the ventricles.
- Neuronavigational guidance proved to be precise and beneficial during the NEFPFMO procedure.
Implications:
- NEFPFMO should be considered the primary treatment for IUH caused by foramen of Monro occlusion.
- The technique facilitates physiological cerebrospinal fluid (CSF) flow, addressing the underlying pathology.
- Neuronavigation serves as a valuable adjunct, enhancing the safety and precision of NEFPFMO.