Endoscopic surgery for monoventricular hydrocephalus

BACKGROUND Monoventricular hydrocephalus is usually treated with extrathecal shunting. However, today endoscopic fenestration of the septum pellucidum seems to be a very useful and less invasive technique. METHODS Five patients with monoventricular hydrocephalus have been treated with neuroendoscopic techniques. In three cases with an excluded lateral ventricle due to contralateral shunt overdrainage, the normal-sized ventricle was first cannulated and fenestration of the septum pellucidum from the normal to the enlarged lateral ventricle was performed. RESULTS Complete remission of intracranial hypertension symptoms and decrease in size of the enlarged ventricle were observed in all five patients. CONCLUSIONS Endoscopic fenestration of the septum pellucidum is the technique of choice for treating monoventricular hydrocephalus. We advise first cannulating the normal lateral ventricle and then performing a septostomy from it to the enlarged ventricle. This approach allows one to easily recognize the protruding septum pellucidum and perform fenestration without difficulty using a direct trajectory. In exceptional cases of choroid plexus cyst obstructing one foramen of Monro, fenestration of the cyst wall is sufficient. (C) 1999 by Elsevier Science Inc.