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Endoscopic stent placement for treatment of secondary bilateral occlusion of the Monro foramina following endoscopic third ventriculostomy in a patient with aqueductal stenosis. Case report.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Nontumoral
bilateral
occlusion
of
the
Monro
foramina
is
a
rare
clinical
condition
.
Treatment
includes
shunt
placement
,
endoscopic
procedures
,
or
both
.
The
authors
describe
the
case
of
a
22
-
year
-old
woman
who
had
previously
undergone
placement
of
a
ventriculoperitoneal
shunt
via
a
right
frontal
approach
for
management
of
triventricular
dilation
due
to
aqueductal
stenosis
.
Six
years
postoperatively
she
presented
with
right
-sided
slit-ventricle
syndrome
and
stenosis
of
the
right
Monro
foramen
,
which
was
treated
with
an
endoscopic
third
ventriculostomy
and
fenestration
of
the
septum
pellucidum
.
Two
years
later
she
presented
with
bilateral
lateral
ventricular
dilation
.
Inspection
of
the
right
lateral
ventricle
with
a
fiberscope
revealed
occlusion
of
the
septum
pellucidum
fenestration
;
on
observation
,
the
right
Monro
foramen
was
covered
by
thick
,
tough
granulation
tissue
and
the
left
was
occluded
by
thin
membranous
tissue
.
Repeated
fenestration
of
the
septum
pellucidum
and
left
Monro
foraminoplasty
were
therefore
performed
by
perforating
this
thin
tissue
.
A
stent
was
then
introduced
into
the
third
ventricle
via
the
right
lateral
ventricle
,
the
fenestration
in
the
septum
pellucidum
,
and
the
left
Monro
foramen
.
The
authors
note
that
fiberscopes
are
in
general
more
maneuverable
than
rigid
endoscopes
and
conclude
that
they
are
particularly
useful
for
the
treatment
of
this
type
of
hydrocephalus
.