Radiosurgical Septostomy: A Technical Report of Two Cases

Septostomy is a surgical procedure in which a hole or fenestration is created in the septum pellucidum, a thin membrane between the brain's lateral ventricles. Here, we describe radiosurgical septostomy as an alternative to the treatment of asymmetric hydrocephalus. We report the cases of two males, 46 years old and 64 years old, diagnosed with meningioma and asymmetric hydrocephalus. Brain MRI and cranial CT showed a left lateral hydrocephalus in both cases. Both patients underwent a radiosurgical septostomy on the TrueBeam STX platform. The target used was the septum pellucidum on its avascular portion. The prescribed doses were 120 Gy and 100 Gy, respectively. After radiosurgical septostomy, symptomatic and imaging improvement was noted. MRI showed a reduction in ventricular dilation over a long follow-up period. There were no treatment failures or complications with the procedure. Radiosurgical septostomy is a minimally invasive, highly precise, secure, and effective treatment modality.