Retrograde third ventriculocisternostomy from the posterior fossa

Area of Science:

• Neurosurgery
• Cerebrospinal Fluid Dynamics
• Surgical Anatomy

Background:

• Postoperative hydrocephalus is a frequent complication following posterior fossa tumor resection.
• Up to 25% of patients may require permanent cerebrospinal fluid diversion (shunting or ventriculocisternostomy).
• Prophylactic ventriculocisternostomy has shown success in preventing postoperative hydrocephalus.

Observation:

• A microsurgical technique for retrograde third ventriculostomy from the posterior fossa is defined.
• A case report details a 32-year-old woman with a large cerebellopontine angle epidermoid tumor.
• The procedure involved simultaneous lesion resection and third ventriculocisternostomy via a suboccipital posterior fossa approach.

Findings:

• The technique accesses the interpeduncular cistern and creates an opening through the tuber cinereum into the third ventricle under direct vision.
• The patient had a 4-year follow-up period.
• This approach allows direct visualization and access to the third ventricle.

Implications:

• Retrograde third ventriculostomy may be a valuable adjunct for patients undergoing posterior fossa lesion resection.
• It is particularly useful for patients with a high risk of requiring permanent cerebrospinal fluid diversion.
• The technique is feasible when exposure of the interpeduncular cistern is available during the primary surgery.