A 49-year-old woman presented with headache, nausea, and vomiting. T1-weighted sagittal (A) and axial (B) magnetic resonance imaging (MRI) scans revealed a small, contrast-enhancing lesion obstructing the aqueduct and thereby inducing triventricular hydrocephalus. 

Contexts in source publication

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... a solid tumor should not exceed 2 cm in diameter (Fig. 1). Cystic lesions may be treated even if they are larger. The endo- scopic removal may become time-consuming and ineffective if the tumor is too large and too firm. The benefit of the mini- mally invasive approach is then outweighed by the duration of the operation, and one should not hesitate to change to an open microsurgical ...

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... is advanced to the foramen of Monro through which the hematoma is removed. For thalamic hemorrhage with ventricular rupture, the hematoma in the lateral ventricle is evacuated first, a sheath is advanced through the rupture point, and then the hematoma in the thalamus is removed. Video of this endoscopic surgery of the left putaminal hemorrhage (Fig. 10) is presented. The burr-hole approach under local anesthesia and the simple surgical instrumentation enable ultra-early surgery in patients for whom standard surgical treatment is controversial, because cerebral herniation may become irreversible during the waiting period for surgery. We have performed this surgical procedure in 150 ...

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... the ETV, attention is turned to the CPC. Using a 3.7-mm flexible steerable neuroendoscope (Karl Storz Co., Tuttlingen, Germany), beginning at the foramen of Monro and gradually moving posteriorly, the choroid plexus of the lateral ventricle is thoroughly cauterized using Bugby wire and low- voltage monopolar coagulating current (Fig. 11A). In cases of severe ventriculomegaly, a portion of the choroid plexus in the anterior roof of the third ventricle is often available for cauter- ization as well. Care is taken to avoid injury to the thalamostri- ate and internal cerebral veins or ependymal surfaces. Special attention is paid to the complete coagulation of all vessels ...

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... in the anterior roof of the third ventricle is often available for cauter- ization as well. Care is taken to avoid injury to the thalamostri- ate and internal cerebral veins or ependymal surfaces. Special attention is paid to the complete coagulation of all vessels within the plexus, including the superior choroidal vein along its entire length (Fig. 11B). At the level of the atrium, the glomus portion of the choroid plexus is thoroughly cauterized. Then, passing the scope posterior to the thalamus, its tip is flexed and turned to direct the procedure along the choroid plexus of the temporal horn, which is then cauterized in similar fashion beginning at its anterior extreme and ...

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... atrium, the glomus portion of the choroid plexus is thoroughly cauterized. Then, passing the scope posterior to the thalamus, its tip is flexed and turned to direct the procedure along the choroid plexus of the temporal horn, which is then cauterized in similar fashion beginning at its anterior extreme and advancing posteriorly along its length (Fig. 12). Cautery is continued until all visible choroid plexus has been coagulated and shriveled. For cases in which the septum pellucidum is intact, a septostomy is per- formed superior to the posterior edge of the foramen of Monro to gain access to the contralateral choroid plexus, where the same procedure is carried out in the left lateral ...

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... should be referred to simply as ventriculocistostomy (20,23,82), because chronic midbrain, compression may cause an aqueductal occlusion that does not resolve after drainage of the cyst (82). In these cases, the basal stoma allows CSF to flow into the basal cisterns bypassing the aqueduct (Fig. ...

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... with resections of these lesions indicate that removal or disconnection can lead to cure (60%) or ameliora- tion (90%) of the seizure disorder in intractable cases (37a, 58a). In some ways, these lesions are ideal candidates for endoscopic resection in that they are focal and have a visible interface with the wall of the third ventricle (Fig. 1). Actually, there are signif- icant challenges. There is no hydrocephalus, and therefore, the ventricles are normal in size. Usually, the foramen of Monro is obscured by the choroid plexus, which must be moved aside to enter the third ventricle (Fig. 2). The interface with the wall of the ventricle is distinct, but there are no visual ...

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... volumetric images are obtained before the procedure (Fig. 14) for the use of frameless stereotaxis (Stealth System; Medtronic Corp., Minneapolis, MN). The patient's head is placed in three-point fixation either in a standard Mayfield apparatus or in a gel headholder specifically designed for the fixation of an infant's head without the need for pins. The head is placed in a face-up position with ...

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... patients who present with a significant cystic component (Fig. 15, A-C) and large ventricles, transventricular endoscopy has some advantages over other drainage techniques (25,59). The burr hole is usually precoronal, because the tumor usually grows into the third ventricle and the cystic component bulges into the lateral ventricles, obstructing the two foramen of Monro and inducing noncommunicating ...

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... allows one to significantly limit the size of the craniotomy even if there is marked suprasellar, retrosellar, or intrasellar extension. This approach has been given many names (transciliary, supraorbital, eyebrow, subfrontal, orbital roof, and so on) and has many variations. The incision can be made either through the eyebrow or above it (Fig. 16), the orbital rim can be taken or preserved, and the sylvian fissure can be split or left alone. We recommend an incision through the eyebrow itself, preserving the supraorbital nerve, and the pericranium. If necessary, the incision can be continued later- ally into the non-hair-bearing area, but this significantly increases the risk of ...

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... the eyebrow itself, preserving the supraorbital nerve, and the pericranium. If necessary, the incision can be continued later- ally into the non-hair-bearing area, but this significantly increases the risk of permanent damage to the frontal branches of the facial nerve. The pericranium is then elevated anteriorly as a separate flap of tissue (Fig. 17), which later provides some barrier to CSF leak or a means of covering a breached frontal sinus. A burr hole is then made in the "key- hole" area and a small craniotomy is fashioned, and attempts are made to leave the frontal sinus intact. The orbital rim can be removed if there is excessive suprasellar extension of the tumor, but in ...

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... incision is made just behind the hairline of the tempo- ral area in a gentle curve, making sure that the anterior limb of the incision does not cross the hairline or approach too close to the frontalis branches of the facial nerve (Fig. 18). The muscle is split in the longitudinal plane and a small cran- iotomy is opened, centered on the pterion. This is a more lat- eral approach that allows excellent dissection through the opticocarotid window. The endoscope can be placed through this craniotomy and used to view superiorly and inferiorly, similar to the subfrontal ...

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... orifices), and a handle attachment knob to which a holding handle can be affixed (Oi Handy Pro; Karl Storz Co.). The three-outlet/inlet orifices are used for irrigation (left), suction (center), and microinstrumen- tation (right). Irrigation and suction procedures are undertaken by opening either the left or center orifice, respectively (Fig. ...

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... vein) during the attempt to reach the tumoral mass in the posterior third ventricle. Placing the burr hole too anteri- orly could put traction on the fornix when performing the ETV. We suggest placing the burr hole between 2 and 3 cm in front of the coronal suture and, in all cases, to study sagittal MRI scans to plan the trajectory in advance (Fig. 1) (31,71). After cannulation with a peel-away sheath, a CSF sample will be obtained for tumor markers and cytological examination. The endoscope can then be introduced in the lateral ventricle, and a third ventriculostomy can be per- formed in a standard fashion. The tumoral mass is biop- sied following two different pathways: either ...