Endoscopic Bimanual Resection of Recurrent Colloid Cyst.

Colloid cysts are nonneoplastic epithelial lesions arising from the roof of the third ventricle near the foramen of Monro. They comprise approximately 0.5% to 2% of all brain lesions.1-3 Surgical resection is the definitive treatment when indicated. The microsurgical approach is generally considered the "gold standard," but the endoscopic approach has been gaining popularity.4-6 The choice is usually based on a surgeon's preference and key image findings such as the presence of hydrocephalus. The advantage of an endoscopic approach is shorter operative time, faster recovery, and a more anterolateral approach to avoid manipulation on the fornix. The major drawback of the endoscopic approach was previously reported as a higher recurrence rate due to incomplete removal of the cyst capsule. However, it has been shown that the rate of capsule excision may be similar to that of microsurgery, ranging from 80 to 100%.7-14 The authors demonstrate an endoscopic resection of a recurrent colloid cyst with bimanual technique through parallel channels in a ventriculoscope. Video 1 highlights the critical steps involved in preserving both vascular and neural structures during the procedure.

Foramen of Monro choroid plexus papilloma: An extremely rare location managed by endoscopic resection.

Choroid plexus papillomas are rare brain neoplasms, primarily observed in children, and typically manifest with symptoms indicative of heightened intracranial pressure and cerebral irritation. In addition, the tumor's localization varies with the patient's age, and diagnostic and therapeutic approaches predominantly rely on imaging findings and surgical interventions, with histopathological examination being essential for confirmation. This study outlines a unique instance of choroid plexus papilloma in a 30-year-old female, who presented with severe headache and vomiting, subsequently revealing hydrocephalus on Brain CT. Remarkably, the tumor was identified in the Foramen of Monro, an exceedingly rare and unreported location in adults. Notably, the patient underwent successful endoscopic resection without complications, a technique sparsely documented in similar cases. Choroid plexus papilloma, predominantly afflicting children, displays varied tumor locations depending on the patient's age. Our report highlights an exceptional case with an atypical tumor location that was not reported before to our knowledge, and addressed through an innovative endoscopic resection method that was recently used in the management of such cases. This underscores the importance of considering diverse tumor presentations, as it has a favorable prognosis achievable through management, especially with the increasing number of reported cases. Moreover, it advocates for the adoption of emerging endoscopic approaches, which exhibit promising outcomes.

Third Ventricular Colloid Cyst, New Surgical Classification.

BACKGROUND: This research discusses colloid cyst surgical concerns, with an emphasis on the value of a novel surgical classification based on anatomical sites. In the study, 59 patients who underwent surgical intervention between 2009 and 2022 and were diagnosed with colloid cysts via computed tomography scan and magnetic resonance imaging participated. METHODS: There were more male cases than female ones (57.6%). The majority of patients presented with headache (79%), followed by abnormal gait (12%), visual blurring (5%), and seizures (4%). RESULTS: In this study, we present a new surgical classification based on anatomical locations, distinguishing 4 types: open Monro type (50.84%), closed Monro type (23.72%), retroforaminal type (13.55%), and interforniceal type (11.86%). CONCLUSIONS: In summary, the surgical classification that has been suggested provides significant insights into the varied anatomical sites where colloid cysts might be found. Microneurosurgeons significantly need to be oriented about the possible sites of colloid cysts through this classification to achieve complete and curative resection and reduce the likelihood of recurrence.

Adult idiopathic bilateral occlusion of foramen of Monro: Systematic review with illustrative case.

BACKGROUND: Adult idiopathic occlusion of foramen of Monro (AIOFM) is a rare condition that results in hydrocephalus, and bilateral presentation is even rarer. Here we report a case of idiopathic bilateral stenosis of the foramen of Monro in an adult patient and performed a systematic literature review on the current treatment options and outcomes. METHODS: We performed a systematic review of SCOPUS, Science Direct, and PubMed databases in accordance with PRISMA guidelines. Data on demographics, clinical presentation, imaging findings, type of AIOFM, treatment, and outcomes were collected. RESULTS: A total of 22 cases of bilateral AIOFM were identified in the literature, including ours. The median age was 38.5 years (range: 20-53), with no sex predilection. The most common presenting symptoms were headache (n=16, 73%) and vomiting (n=10, 45%). There were 9 cases of Type 1 AIOFM (stenosis) and 13 cases of Type 2 (membrane occlusion). Majority of patients underwent surgical treatment, mostly endoscopic unilateral foraminoplasty and septostomy (59%), followed by ventriculoperitoneal shunt insertion (31%). One patient underwent medical management only to alleviate her presenting symptoms (seizures). The overall outcome was good for majority of patients at a median follow-up of 6 months. CONCLUSION: Bilateral AIOFM is a rare condition that may easily be missed, so neurosurgeons should be cognizant of this disease entity. Identification of the type of AIOFM may guide surgical decision-making. Treatment options include neuroendoscopic procedures such as septostomy and foraminoplasty, and ventriculoperitoneal shunt insertion.

Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty.

OBJECT: One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature. METHODS: A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted. RESULTS: In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies. CONCLUSION: Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.

Septostomy and Monroplasty in Isolated Lateral Ventricle After Removal of a Third Ventricle Colloid Cyst: 2-Dimensional Operative Video.

Isolated unilateral hydrocephalus (IUH) is a condition caused by unilateral obstruction of the foramen of Monro.1 Etiopathogenic causes include tumors, congenital lesions, infective ventriculitis, intraventricular haemorrhage, and iatrogenic causes such as the presence of contralateral shunts.2,3 Neuroendoscopic management is considered the "gold-standard" treatment in IUH.4 Even if endoscopic septostomy and foraminoplasty in IUH are well-known procedures,5,6 IUH after an interhemispheric transcallosal transchoroidal approach for removal of a III ventricle colloid cyst is a complication barely described in literature. Video 1 describes this rare complication and the neuroendoscopic treatment adopted, including the operative room setup, patient's positioning, instrumentation needed, and a series of intraoperative tips for the performance of septostomy and Monroplasty via a single, precoronal burr hole. The scalp entry point and endoscope trajectory, homolateral to the dilated ventricle, were planned on the neuronavigation system. The avascular septal zone away from the septal veins and body of the fornix was reached, and the ostomy was performed. At the end of the procedure, Monroplasty was performed, too. The procedure was effective in solving the hydrocephalus and patient's clinical picture. No surgical complications occurred. Imaging demonstrated an evident and progressive reduction of enlarged lateral ventricle. In authors' opinion, the single burr-hole approach, ipsilateral to the enlarged ventricle, provides an optimal identification the intraventricular anatomy and allows Monroplasty to be performed, if deemed feasible during surgery. The patient consented to the procedure. The participants and any identifiable individuals consented to publication of their images.

Colloid Cyst Presenting With Severe Headache and Bilateral Leg Weakness: Case Report and Review.

Colloid cysts are benign growths commonly found in the third ventricle at the foramen of Monro. They can be asymptomatic or present with a variety of symptoms, including headaches, diplopia, memory problems, psychosis, urinary incontinence, and ataxia. Obstructive hydrocephalus from a colloid cyst is caused by a blockage of cerebral spinal fluid (CSF) from the lateral ventricles at the foramen of Monro. Colloid cysts have rarely been reported to cause sudden death. Here we present the case of a 32-year-old female with a known history of a colloid cyst who presented with a headache and transient weakness in her lower extremities noted while climbing stairs.

Extensive cerebral venous thrombosis after resection of third ventricle colloid cyst.

Background: The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them. Case Description: A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a 6-month history of headaches, blurred vision, and vomiting presented to our clinic 3 days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography and magnetic resonance imaging confirmed the presence of a third ventricle CC and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days postoperatively, the patient developed further headaches followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from chronic mild headaches. Conclusion: A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.

Endoscope-assisted microsurgical resection of a third ventricular immature teratoma.

BACKGROUND: Reaching a tumor within the third ventricle is challenging, and planning an accessible trajectory is crucial without injuring the surrounding structures. We report a 5-year-old boy presented with headache and a seizure where sequential MRI brain studies in a short time period revealed a rapid growing immature teratoma within the third ventricle with hydrocephalic changes. Several management procedures were performed for CSF diversion and medical treatment of the tumor with chemotherapy and stem cell therapy. The tumor was rapidly growing, and surgical excision was decided. Total resection was achieved via endoscope-assisted microsurgical transcallosal approach. Seven years after surgery, the patient experienced no recurrence of the tumor with a favorable clinical condition. CONCLUSION: We report a rare case of posterior third ventricular immature teratoma where the endoscope-assisted microsurgical technique was implemented with favorable long-term postoperative outcome.

Idiopathic membranous occlusion of the foramen of Monro: an unusual cause of hydrocephalus and headache in adults.

Occlusion of foramen of Monro is an uncommon clinical entity that usually presents in children. Common causes are obstructing mass, infectious etiologies or vascular malformation. Rarely, it may be an idiopathic stricture or membrane. We report a case of idiopathic membranous obstruction of the foramen of Monro in a 45-year-old male with no past medical or surgical history. He presented with new intermittent dull and burning bifrontal severe headache for 2 d, which was alleviated slightly by non-steroidal anti-inflammatory medication. Imaging showed marked dilation of the lateral ventricles with normal third and fourth ventricles. The patient was discharged initially with conservative medical management and close follows up; however, the headache continued to progress and neurosurgical intervention was offered. The patient underwent endoscopic exploration, fenestration of the septum pellucidum, and right ventriculoperitoneal shunt placement. Bilateral membranous obstruction of foramina of Monro and an auto-fenestrated cavum septum pellucidum were identified intraoperatively. The patient reported resolution of headache post-operatively without recurrence on 1-month follow up. This case is unusual in that the patient presented without any known neurologic history or prior intracranial infections. It became apparent at the time of surgery that chronic obstruction of the bilateral foramina with collapse of the third ventricle had developed, and the safest durable treatment for him was septostomy and cerebrospinal fluid (CSF) shunt placement.

Case Report: Occlusion of the foramen of Monro treated with endoscopic septostomy and foraminotomy in a preterm neonate.

Background: Hydrocephalus is a brain abnormality frequently encountered in neonates. There are several known etiologies of hydrocephalus, which can be classified as either congenital or acquired. Occlusion of the foramen of Monro (FOM) is a cause of hydrocephalus and can be either congenital or secondary to various disorders. Idiopathic obstruction of the FOM presenting as prenatal ventriculomegaly is extremely rare but has been reported. Case presentation: We present the case of a preterm newborn with severe bilateral hydrocephalus due to FOM occlusion in the prenatal period. Although the neonate had normal head circumference and no clinical symptoms after birth, brain sonography revealed progressive ventriculomegaly. Further image revealed bilateral ventriculomegaly with normal-sized third and fourth ventricles. We suspected a complete obstruction of the right and a partial obstruction of the left of the FOM. The neonate underwent endoscopic septostomy and foraminotomy, resulting in improvement. Conclusion: We report a case of preterm FOM occlusion in the youngest and smallest neonate to date. Endoscopic septostomy and foraminotomy were performed in order to avoid ventriculoperitoneal shunt-related complications, highlighting the viability of endoscopic procedures which should be the primary treatment in preterm neonates with FOM occlusion.

Giant Colloid Cyst.

Giant colloid cysts are defined as cysts of more than 3 cm in maximal diameter. Few cases of giant colloid cysts have been reported in the literature. We herein describe a giant colloid cyst. A 15-year-old female presented with headache, blurred vision, and episodic behavioral changes for 3 months. Neurological examination was limited due to agitation and confusion. Fundoscopy was notable for bilateral papilledema. Brain computed tomography revealed a giant third-ventricular lesion, causing obstructive hydrocephalus. The patient underwent urgent ventriculoperitoneal shunt insertion initially and then cyst excision. The histopathological sections of the lesion were compatible with a colloid cyst. Five years following surgical resection, a brain magnetic resonance imaging did not demonstrate any evidence of residual or cyst recurrence. To our knowledge, giant colloid cysts have been rarely reported and pose a management dilemma in the literature. The present article highlights the symptomatology, radiological findings, and outcome of a giant colloid cyst.

Customising the surgical management for intraventricular meningiomas - 'one size doesn't fit all'.

BACKGROUND: Intraventricular meningiomas are uncommon and gross total resection is the recommended treatment. However, total resection may not always be possible, especially in locations in which the lesions are adherent to veins and neural structures. We share our experience with intraventricular meningiomas, focusing on the management strategies and outcomes. PATIENTS AND METHODS: We describe the data of 7 patients with intraventricular meningiomas operated at our institute over the last 9 years. Three patients had a third ventricular tumor of which two had lesions straddling across the foramen of Monro. The remaining 4 patients had trigonal mass. The clinico-radiological features, management strategies and outcomes have been elaborated with a mean follow-up of 57 months. RESULTS: The common clinical presentations were raised intracranial pressure symptoms, visual field defects and memory deficits. One patient had multiple meningiomas. Total excision was achieved in all except in 2 patients in whom the lesion straddled across the foramen of Monro with dense adhesions to veins and neural structures. Staged resection was required in one patient with a large trigonal mass. All patients had a low-grade lesion. The tumor recurred in one patient (post-pregnancy) after partial resection. All the patients improved neurologically, and none had added deficits. CONCLUSIONS: Gross total resection of intraventricular meningiomas although desirable may not be possible in certain cases in which the risks outweigh the benefits. These tumors often are of low histological grade and the treatment strategies should be individualized. Regular follow-up is warranted as these tumors may recur despite a low histological grade.

Susceptibility weighted imaging of the veins around foramen of monro / 解剖学报

Objective To image the veins around the foramen of monro (FM), to build the 3D model of them, to construct venous network in this area and to explore the spatial positional correlation between FM and veins around it. Methods Totally 60 healthy subjects were selected to get the original images on 3. 0 T MR and procesed the original images by minimum intensity projections (mIP) and Materialise’ s interactive medical image control system (Mimics), built the 3D model of the veins around FM, observed and analyzed the morphology of FM and the veins around it on original and processed images. Results The displaying rate of FM was 65% (78 sides), the displaying rate of internal cerebellar veins (ICV) was 100% (120 sides), the diameter was (2. 13±0. 30) mm. The displaying rate of anterior septal vein (ASV) was 100% (120 sides), the diameter was(0. 69±0. 19)mm. The displaying rate of superior thalamostriate vein (STV) was 98. 3% (118 sides), the diameter was (1. 47± 0. 38) mm. The displaying rate of superior choroidal vein (SCV) was 82. 5% (99 sides), the diameter was(0. 40±0. 18)mm. According to the relationship between the converging point of the tributaries of ICV and the location of FM, FMs were classified into 5 types:ⅠA, 24. 2% (29 sides), ASV converged into ICV at the venous angle and closed to the posterior edge of FM; ⅠB, 13. 3% (16 sides), ASV converged into ICV away from the venous angle and the posterior edge of FM; ⅡA, 45% (54 sides), ASV converged into ICV at the false venous angle and closed to the posterior edge of FM; ⅡB, 15. 8% (19 sides), ASV converged into ICV away form the false venous angle and the posterior edge of FM. Ⅲ, 1. 7% (2 sides), STV was absent. Conclusion FM and the veins around it are visible on the susceptibility weighted imaging(SWI). It can be constructed by Mimics that the 3D model of ICV, its tributaries, FM and the converging points of the major veins. The classification of FMs is meaningful to the option of surgical approaches through FM.

A Rare Case of Choroid Plexus Papilloma of the Third Ventricle in an Adult.

Colloid cysts are the commonest masses of the third ventricle. Third ventricle neoplasms are uncommon. They include tumors arising from the choroid plexus (papillomas, carcinomas), tumors arising from other than the choroid plexus (ependymomas, meningiomas), metastases, and lymphoma. Choroid plexus tumors usually occur in the lateral ventricle in children and fourth ventricle in adults, and often present with hydrocephalus. We herein describe the extremely rare occurrence of third ventricle choroid plexus papilloma in a 35-year-old man who presented to the emergency department with a long history of intermittent headaches, occasionally associated with photophobia. CT and MR imaging revealed a lobulated ovoid lesion in the third ventricle with minimal extension into the right lateral ventricle through the foramen of Monro, causing mild ventricular dilatation. Surgical resection was performed and histopathology revealed choroid plexus papilloma.

Unilateral Hydrocephalus Due to Lateral Ventricle Colloid Cyst Treated by Neuroendoscopic Approach.

Colloid cysts (CCs) are rare brain tumors that cause nonspecific neurological signs associated with acute or chronic increased intracranial pressure. They are usually located in the third ventricle and rarely in the lateral ventricle. This is a report of an unusual case of CC located in the lateral ventricle. A 36-year-old male patient presented a story of progressive holocranial headache that would get worse with head mobilization and cough. Radiological analysis demonstrated enlargement of the right lateral ventricle due to a cyst blocking the right foramen of Monro. The patient underwent endoscopic neurosurgery and the cyst was totally resected. Histological evaluation diagnosed a CC. Postoperative images showed no cyst remaining and normalized ventricular size. The patient evolved with total improvement of the symptoms. Literature review shows that it is a very uncommon entity. Lateral ventricle CCs as a cause for unilateral hydrocephalus is a very rare entity. Neuroendoscopic approach is a first-line treatment option for this condition.

Clinical Significance of the CSF Pulsation Flow Sign in the Foramen of Monro on FLAIR in Patients with Aneurysmal SAH -Preliminary Report.

It is known that the cerebrospinal fluid (CSF) pulsation flow sign in the lateral ventricles directly above the foramen of Monro (CPF-M) on axial fluid attenuated inversion recovery (FLAIR) is a normal physiological finding as an artifact of FLAIR. In this study, whether CPF-M can be used as a neuroradiological finding related to pathological conditions in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) was investigated. CPF-M-related clinical features were retrospectively evaluated in 147 aSAH patients who underwent adequate serial MRI examinations without massive intraventricular hemorrhage (IVH) of the lateral ventricle within 48 h of ictus. The frequency of the CPF-M in the control group was 32% (57/178), 33% (40/123), and 38% (45/117) for the normal control, chronic cerebral infarction, and deep white matter lesion (WML) groups, respectively. In aSAH patients, the overall prevalence of the CPF-M was 57% (84/147), significantly higher than in the three control groups. Multivariate analysis showed that age <70 years, lower IVH Hijdra score of the fourth ventricle, absence of T1-FLAIR mismatch, deep WMLs, old infarction, diffuse brain swelling, symptomatic delayed cerebral ischemia (DCI), shunt-dependent chronic hydrocephalus (SDCH), and favorable outcome were significantly associated with the CPF-M. Although limited to SAH patients without massive IVH of the lateral ventricles, one can conclude that, in acute aSAH, the presence of CPF-M on admission MRI suggests that the circulatory dynamics of the CSF from the basal cistern to the ventricles are approximately normal. Thus, this finding may appear to offer an indicator of a good outcome without DCI and SDCH.

An anatomical study of the foramen of Monro: implications in management of pineal tumors presenting with hydrocephalus.

BACKGROUND: For pineal tumors presenting with hydrocephalus, simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy is commonly used as the initial step in management. To analyze the restriction which the foramen of Monro poses to this procedure, one must start with a detailed description of the microsurgical anatomy of the foramen in living subjects. However, the orientation and shape of the foramen of Monro make this description difficult with conventional imaging techniques. METHOD: Virtual reality technology was applied on MRIs on living subject without hydrocephalus, as well as patients with hydrocephalus, to generate precise anatomical models with sub-millimeter accuracy. The morphometry of the foramen of Monro was studied in each group. In addition, displacement of the margins of the foramen was studied in detail for simultaneous ETV and pineal tumor biopsy through a single burr hole. RESULTS: In 30 normal subjects, the foramen of Monro had oval-shaped openings averaging 5.23 mm2. The foramen was larger in people above age 55 (p = 0.007) and on the left side compared to the right (p = 0.002). For patients with clinical presentation of hydrocephalus, the average opening was 32.6 mm2. Simulated single burr hole simultaneous ETV and pineal tumor biopsy was performed in 10 specimens. Average displacement of the posterior and anterior margins of the foramen was 5.71 mm and 5.76 mm, respectively. However, maximum displacement reached 9.3 mm posteriorly and 10 mm anteriorly. CONCLUSIONS: The foramen of Monro is an oval-shaped cylinder that changes in size and orientation in the hydrocephalic patient. If universally applied to all patients regardless of foramen and tumor size, ETV/biopsy can displace structures around the Foramen of Monro up to 1 cm, which can potentially lead to neurological damage. Careful pre-operative assessment is critical to determine if a single burr hole approach is safe.

Relationship between the location of the ventricular catheter tip and the ventriculoperitoneal shunt malfunction.

OBJECTIVE: Ventriculoperitoneal (VP) shunt is the most common neurosurgical procedure to treat obstructive and communicating hydrocephalus, but failures are frequent. The most common causes of shunt failure are malpositioning and obstruction of the ventricular catheter by debris or blood clothes. The knowledge of the relationship between ventricular catheter tip position, etiology of hydrocephalus and patient's age with shunt malfunction may be useful to avoid shunt failure. PATIENTS AND METHODS: We retrospectively analyze 89 adult patients affected by obstructive and communicating hydrocephalus operated with Ventriculoperitoneal shunt at our Institute. Patients with evident abdominal shunt malfunction were excluded from this study. Statistical analysis was performed in the group of patients with intracranial catheter malfunction in order to correlate shunt malfunction with the position of the catheter tip in brain ventricles, etiology of hydrocephalus and patient's age. RESULTS: Shunt revision was performed in 26 patients out of 89 and cranial catheter malfunction was documented in 11 patients out of 26. Tip position in Monro foramen, lateral ventricles and third ventricle ("good position") had a lower rate of surgical shunt revision compared to septum pellucidum and wall of lateral ventricle ("bad position") p value = 0,049. No statistical significant association was observed between shunt malfunction and etiology of the hydrocephalus or patient's age. CONCLUSIONS: Ventricular catheter tip position is one the most important factor for shunt function.

Neuroendoscopic Management of Coexisting Congenital Agenesis of Bilateral Foramen of Monro with Aqueductal Stenosis and Chiari Malformation: Case Report and Review of the Literature.

BACKGROUND: Bilateral occlusion of the foramen of Monro with aqueductal stenosis is a rare entity. Only 1 previous case has been reported in the literature. CASE DESCRIPTION: We present a 25-year-old female who presented with chronic headache of 7 years duration. Neurologic examination revealed only papilledema. Imaging showed symmetrical dilation of both lateral ventricles with mild dilation of the third ventricle and a normal fourth ventricle, suggesting occlusion of both foramina of Monro with membranous web formation in the upper part of the aqueduct. There was tonsillar herniation without syrinx. She underwent neuroendoscopic foraminoplasty, septostomy, and third ventriculostomy. The patient experienced total relief of headache and showed reduced volume of both lateral ventricles at follow-up. CONCLUSIONS: Bilateral occlusion of foramen of Monro with aqueductal stenosis and tonsillar herniation is rare cause of obstructive hydrocephalus, and can be managed effectively with neuroendoscopic procedure.