Bilateral Stenosis of Interventricular Foramen (of Monro)

OBJECTIVE At present, endoscopic treatment is advised as the first procedure in cases of suprasellar arachnoid cysts (SSCs) with hydrocephalus. However, the appropriate therapy for SSCs without hydrocephalus has not been fully determined yet because such cases are very rare and because it is usually difficult to perform the neuroendoscopic procedure in patients without ventriculomegaly given difficulties with ventricular cannulation and the narrow foramen of Monro. The purpose of this study was to find out the value of navigation-guided neuroendoscopic ventriculocystocisternostomy (VCC) for SSCs without lateral ventriculomegaly. METHODS Five consecutive patients with SSC without hydrocephalus were surgically treated using endoscopic fenestration (VCC) guided by navigation between March 2014 and November 2015. The surgical technique, success rate, and patient outcomes were assessed and compared with those from hydrocephalic patients managed in a similar fashion. RESULTS The small ventricles were successfully cannulated using navigational tracking, and the VCC was accomplished in all patients. There were no operative complications related to the endoscopic procedure. In all patients the SSC decreased in size and symptoms improved postoperatively (mean follow-up 10.4 months). CONCLUSIONS Endoscopic VCC can be performed as an effective, safe, and simple treatment option by using intraoperative image-based neuronavigation in SSC patients without hydrocephalus. The image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of hydrocephalus in patients with SSC may not be a contraindication to endoscopic treatment.

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Neurosurgical management of a giant colloid cyst with atypical clinical and radiological presentation

Journal of Neurosurgery ◽

10.3171/2014.7.jns14242 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1185-1188 ◽

Cited By ~ 5

Author(s):

Joel Woodley-Cook ◽

Jaime L. Martinez ◽

Anish Kapadia ◽

David G. Munoz ◽

Aditya Bharatha ◽

...

Keyword(s):

Vision Loss ◽

Obstructive Hydrocephalus ◽

Memory Loss ◽

Final Diagnosis ◽

Colloid Cyst ◽

Ct Scans ◽

Mr Images ◽

Diagnostic Dilemma ◽

Foramen Of Monro ◽

Histopathological Investigation

The finding of a colloid cyst on neuroimaging is often incidental. These lesions are usually located at the foramen of Monro, are hyperdense on CT scans, and generally demonstrate signal intensity of water on MR images, although this depends on their content. When symptomatic, they frequently present with headaches and nausea due to an obstructive hydrocephalus. The authors describe a case of a giant colloid cyst in a patient presenting with complete left-sided vision loss and progressive memory loss, two very atypical findings in colloid cyst presentation. Imaging findings were also atypical, and this case proved to be a diagnostic dilemma because of its clinical and radiological presentation. Histopathological investigation was of utmost importance in the final diagnosis of a colloid cyst. To the authors' knowledge this colloid cyst is larger than any other described in the literature.

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Obliteration of the choroid plexus after endoscopic coagulation

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.6.peds1438 ◽

2014 ◽

Vol 14 (3) ◽

pp. 230-233 ◽

Cited By ~ 11

Author(s):

Hideki Ogiwara ◽

Kodai Uematsu ◽

Nobuhito Morota

Keyword(s):

Choroid Plexus ◽

Demographic Data ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Infantile Hydrocephalus ◽

Foramen Of Monro ◽

Initial Surgery ◽

Endoscopic Observation ◽

The Mean

Object Endoscopic choroid plexus coagulation (CPC) with or without endoscopic third ventriculostomy (ETV) has been shown to be effective for selected patients with hydrocephalus. However, whether the effect of the coagulation is temporary and the choroid plexus regenerates or can be obliterated has remained largely unknown. The authors evaluate the effectiveness of CPC and report 3 cases of obliteration demonstrated by direct endoscopic observation. Methods The authors retrospectively analyzed the surgical results of patients with hydrocephalus primarily treated by CPC with or without ETV. Charts were reviewed for demographic data, clinical presentations, surgical therapies, and clinical outcomes. Results Eighteen patients with hydrocephalus were surgically treated using endoscopic CPC between July 2002 and July 2012. In 12 patients, ETV was concurrently performed. The etiology of hydrocephalus was posthemorrhagic in 5 patients, myelomeningocele in 3, postmeningitis in 2, congenital aqueductal stenosis in 1, hydranencephaly in 1, porencephaly in 1, and idiopathic in 5. The mean age at surgery was 8 months (range 0.3–24 months). The mean follow-up was 64 months. In 9 cases (50%), control of hydrocephalus was successful and the patients did not require further surgeries. In 9 patients (50%), treatment failed. Of these, 3 patients underwent repeat ETV 2, 3, and 38 months after the initial surgery. Endoscopic observation of the previous coagulation site revealed no regeneration of the choroid plexus in 2 patients, who underwent repeat ETV 2 and 3 months after CPC. In 1 patient who underwent repeat ETV 38 months after CPC, no regeneration of the choroid plexus, except for that in the proximity of the foramen of Monro, was observed. Conclusions Endoscopic CPC with or without ETV can be a safe and effective treatment alternative to shunt placement in infantile hydrocephalus. Obliteration of the choroid plexus can persist in the relatively long term following CPC, which may contribute to the long-term control of hydrocephalus in successful cases.

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Validation of Sonographic Fronto-Occipital Ratio Based on Anatomical Landmarks compared to MR/CT-Derived Indexes in Children with Chiari II and Ventriculomegaly

Pediatric Neurosurgery ◽

10.1159/000521622 ◽

2021 ◽

Author(s):

Michele Retrouvey ◽

Arastoo Vossough ◽

Alireza Zandifar ◽

Richard D. Bellah ◽

Gregory G. Heuer ◽

...

Keyword(s):

Pearson Correlation ◽

Correlation Coefficients ◽

Ventricular Volume ◽

Coronal Plane ◽

Anatomical Landmarks ◽

Foramen Of Monro ◽

Rater Reliability ◽

Unique Challenge ◽

Frontal Horn ◽

Chiari Ii

Introduction: Ultrasound (US) based indexes such as fronto-occipital ratio (FOR) can be used to obtain an acceptable estimation of ventricular volume. Patients with colpocephaly present a unique challenge due to the shape of their ventricles. In the present study, we aim to evaluate the validity and reproducibility of modified US-FOR index in children with Chiari II-related ventriculomegaly. Methods: In this retrospective study, we evaluated Chiari II patients younger than one year who underwent head US and MR or CT scans for ventriculomegaly evaluation. MR/CT based FOR was measured in the axial plane by identifying the widest diameter of frontal horns, occipital horns, and the interparietal diameter (IPD). US based FOR (US-FOR) was measured using the largest diameter based on the following landmarks: frontal horn and IPD in the coronal plane at the level of the foramen of Monro, IPD just superior to the Sylvian fissures, and occipital horn posterior to the thalami and inferior to the superior margins of the thalami. Interclass correlation coefficients (ICC) were used to evaluate inter-rater reliability and Pearson correlation coefficients and Bland-Altman plots were applied to assess agreement between US and other two modalities. Results: Ninety paired US and MR/CT exams were assessed for agreement between US-FOR and MR/CT-FOR measurements. ICC showed an excellent inter-rater reliability for US-FOR (ICC=0.99, p<0.001) and MR/CT-FOR measurements (ICC=0.99, p<0.001). The mean (range) values based on US-FOR showed a slight overestimation in comparison to MR/CT-FOR [0.51 (0.36-0.68) vs 0.46 (0.34-0.64)]. Pearson correlation coefficient showed high cross-modality agreement for the FOR index (r=0.83, p<0.001). Bland-Altman plot showed excellent concordance between US-FOR and MR/CT-FOR with a bias of 0.05 (95% CI, -0.03-0.13) Conclusion: US-FOR in the coronal plane is a comparable tool for evaluating ventriculomegaly in Chiari II patients when compared with MR/CT-FOR, even in the context of colpocephaly.

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Fetal nondopaminergic neural implants in parkinsonian primates

Journal of Neurosurgery ◽

10.3171/jns.1991.74.1.0097 ◽

1991 ◽

Vol 74 (1) ◽

pp. 97-104 ◽

Cited By ~ 88

Author(s):

Krzysztof S. Bankiewicz ◽

Robert J. Plunkett ◽

David M. Jacobowitz ◽

Irwin J. Kopin ◽

Edward H. Oldfield

Keyword(s):

Dopaminergic Neurons ◽

Neural Implants ◽

Behavioral Recovery ◽

Foramen Of Monro ◽

Caudate Nuclei ◽

Content Type ◽

Primate Brain ◽

Brain Implants ◽

Microsurgical Approach ◽

Fine Print

✓ Implantation of fetal dopamine-containing tissue into preformed cavities in the caudate nucleus of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonian monkeys leads to behavioral recovery. Recovery may be related to two sources of dopamine: the grafted cells and/or the sprouted fibers from host dopaminergic neurons. The authors undertook this study to determine whether behavioral recovery requires release of dopamine by the implanted tissue, and to establish if nondopaminergic fetal central nervous system implants can induce sprouting of dopamine fibers in the primate brain and cause behavioral recovery. Rhesus monkeys with MPTP-induced hemiparkinsonism or full parkinsonism and a stable neurological deficit were used for this study. Cavities were created in the caudate nuclei anterior to the foramen of Monro via an open microsurgical approach. Fetal cerebellum or spinal cord was implanted into the preformed cavities of three monkeys. Control parkinsonian monkeys showed no recovery. However, implant-induced improvement was stable for up to 6 months after implantation. Sprouted dopaminergic fibers oriented from the ventral striatum and nucleus accumbens were found in the area of the tissue implant in the animals that received fetal grafts but were not present in the control monkeys. It is concluded that brain implants do not need to contain dopamine to induce functional recovery in MPTP-induced parkinsonian primates. Implant-induced and trophic factor-mediated dopaminergic sprouting by the host brain plays a role in the behavioral recovery and may well be responsible for the clinical improvement seen in parkinsonian patients after brain implants.

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Early surgical management of antenatal diagnosed cystic lesions of the foramen of Monro causing monoventricular hydrocephalus

Child s Nervous System ◽

10.1007/s00381-009-0890-y ◽

2009 ◽

Vol 25 (9) ◽

pp. 1131-1135 ◽

Cited By ~ 5

Author(s):

Sébastien Freppel ◽

Jean-Claude Marchal ◽

Anthony Joud ◽

Catherine Pinelli ◽

Olivier Klein

Keyword(s):

Surgical Management ◽

Cystic Lesions ◽

Foramen Of Monro

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Organic and psychogenic factors leading to executive dysfunctions in a patient suffering from surgery of a colloid cyst of the Foramen of Monro

Neurocase ◽

10.1080/13554790490894002 ◽

2004 ◽

Vol 10 (6) ◽

pp. 420-425 ◽

Cited By ~ 29

Author(s):

Matthias Brand ◽

Elke Kalbe ◽

Lutz W. Kracht ◽

Ulrich Riebel ◽

Jürgen Münch ◽

...

Keyword(s):

Colloid Cyst ◽

Foramen Of Monro ◽

Executive Dysfunctions

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Third ventricular colloid cyst causing acute hydrocephalus during early pregnancy: Clinical lessons from a case

Surgical Neurology International ◽

10.25259/sni_724_2020 ◽

2021 ◽

Vol 12 ◽

pp. 54

Author(s):

Ching Chung Foo ◽

Pasquale Gallo ◽

Chandrasekaran Kaliaperumal

Keyword(s):

Obstructive Hydrocephalus ◽

Third Ventricle ◽

False Negative ◽

Colloid Cyst ◽

Radiological Investigation ◽

Foramen Of Monro ◽

Acute Hydrocephalus ◽

Healthy Neonate ◽

Trimester Pregnancy ◽

Colloid Cysts

Background: Colloid cysts of third ventricle are rare lesions which may present with symptoms of acute hydrocephalus. We report a case of acute obstructive hydrocephalus secondary to third ventricular colloid cyst and its management during 1st trimester pregnancy. Case Description: A 31-years-old lady presented to the emergency department with reduced consciousness. Computed tomography head showed obstructive hydrocephalus and an obstructing lesion near foramen of Monro suggestive of third ventricle colloid cyst. She underwent endoscopic resection of colloid cyst. Her pregnancy was only confirmed after surgery and she delivered a healthy neonate at full term. She has remained clinically well and had resumed her work as a general practitioner. Conclusion: This case illustrates that urinary pregnancy test may show false negative result but pregnancy should not preclude radiological investigation and neurosurgical intervention in patients with deteriorating neurological function.

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Frameless neuronavigation in intracranial endoscopic neurosurgery

Journal of Neurosurgery ◽

10.3171/jns.2001.94.1.0072 ◽

2001 ◽

Vol 94 (1) ◽

pp. 72-79 ◽

Cited By ~ 85

Author(s):

Henry W. S. Schroeder ◽

Wolfgang Wagner ◽

Wolfgang Tschiltschke ◽

Michael R. Gaab

Keyword(s):

Third Ventricle ◽

Colloid Cyst ◽

Endoscopic Approach ◽

Arachnoid Cysts ◽

Tumor Biopsy ◽

Foramen Of Monro ◽

Endoscopic Neurosurgery ◽

Content Type ◽

Multiloculated Hydrocephalus ◽

Fine Print

Object. Frameless computerized neuronavigation has been increasingly used in intracranial endoscopic neurosurgery. However, clear indications for the application of neuronavigation in neuroendoscopy have not yet been defined. The purpose of this study was to determine in which intracranial neuroendoscopic procedures frameless neuronavigation is necessary and really beneficial compared with a free-hand endoscopic approach. Methods. A frameless infrared-based computerized neuronavigation system was used in 44 patients who underwent intracranial endoscopic procedures, including 13 third ventriculostomies, nine aqueductoplasties, eight intraventricular tumor biopsy procedures or resections, six cystocisternostomies in arachnoid cysts, five colloid cyst removals, four septostomies in multiloculated hydrocephalus, four cystoventriculostomies in intraparenchymal cysts, two aqueductal stent placements, and fenestration of one pineal cyst and one cavum veli interpositi. All interventions were successfully accomplished. In all procedures, the navigational system guided the surgeons precisely to the target. Navigational tracking was helpful in entering small ventricles, in approaching the posterior third ventricle when the foramen of Monro was narrow, and in selecting the best approach to colloid cysts. Neuronavigation was essential in some cystic lesions lacking clear landmarks, such as intraparenchymal cysts or multiloculated hydrocephalus. Neuronavigation was not necessary in standard third ventriculostomies, tumor biopsy procedures, and large sylvian arachnoid cysts, or for approaching the posterior third ventricle when the foramen of Monro was enlarged. Conclusions. Frameless neuronavigation has proven to be accurate, reliable, and extremely useful in selected intracranial neuroendoscopic procedures. Image-guided neuroendoscopy improved the accuracy of the endoscopic approach and minimized brain trauma.

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