Neuroendoscopic Treatment of Idiopathic Occlusion of the Foramen of Monro in Adults. Two Case Reports.

Abstract

Two adults presented with hydrocephalus due to idiopathic obstruction of the bilateral foramina of Monro, manifesting as clinical signs of chronically elevated intracranial pressure. No inflammation was present. The primary surgical treatment was neuroendoscopic reconstruction of the right foramen of Monro. A 37-year-old man had a spontaneous perforation of the septum pellucidum. The patient required a ventriculoperitoneal shunt, although postoperative ventriculography proved free passage of cerebrospinal fluid from the lateral ventricle into the third ventricle. A 62-year-old man underwent additional septostomy and third ventriculostomy, and the neuroendoscopic intervention relieved the presenting symptoms without additional treatment. The biopsy specimens showed no evidence of malignancy in either case. Neuroendoscopic intervention is an alternative treatment in the management of hydrocephalus due to idiopathic obstruction of the foramen of Monro. The procedure is less invasive than open microsurgical reconstruction and can even avoid ventriculoperitoneal or ventriculoatrial shunting.

Biventricular Hydrocephalus Due to Idiopatic Occlussion of Foramina of Monro

“…[1][2][3][4][5] After studying the other 8 cases of this entity, which have been published, we observed that the most frequent presenting symptom was headache, like in our case. It is more common in infants or children.…”

Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy

“…However, 10 of 13 patients combined from recent series had acceptable outcome without the need for a shunt after the procedure (Table 1). 8,11,13,15,16,21,25 Foraminoplasty may be performed safely in the presence of a thin avascular membrane covering the foramen. 13 However, if the foramen is atretic or obscured, there is increased risk of injury to the fornix.…”

Neuroendoscopic foraminoplasty for bilateral idiopathic occlusion of foramina of monro

“…Obstruction of the Monro foramen and consecutive hydrocephalus may be the result of thalamic and intraventricular neoplasia, colloid cysts, tuberculous masses, ventriculitis, vascular malformations and non-specific inflammatory conditions (1,4,6,7,14). Idiopathic occlusion of the foramen of Monro, a condition in which no background pathology could be found, is an extremely rare phenomenon, in which the foramen of Monro may be occluded by a membrane or may be atretic (5,16).…”

“…AV malformation of the choroid plexus (4,14), and basilar artery aneurysm or ectasia (7)), or iatrogenic complications. Idiopathic occlusion of foramen of Monro, a situation in which no clue can be detected to the etiology of foraminal obstruction, is an extremely rare phenomenon in adults with only five cases of bilateral and ten cases of unilateral obstruction reported in the literature (6,(10)(11)(12)(13)15). …”

“…In the mentioned reported cases, the different treatment modalities that have been used for such patients are divided into open surgical procedures including open microsurgical reconstruction of foramen of monro septum pellucidostomy and shunt placement, and endoscopic techniques (6), which as minimally invasive surgery should become the center of attention in selection of the appropriate approach for unilateral or bilateral occlusion of foramen of Monro.…”