Neuroendoscopic treatment of idiopathic occlusion of unilateral foramen of Monro presenting as chronic headache

Abstract

Asymmetric ventriculomegly due to idiopathic occlusion of the foramen of Monro is rare. Such patients present with clinical features of raised intracranial pressure (ICP). Presentation as chronic headache has not been previously described. In the absence of raised ICP, pursuing surgical treatment raises a clinical dilemma as the headache may be a primary headache with no improvement after surgery. A 21-year-old woman presented with chronic headache. She was found to have asymmetric ventriculomegaly due to the occlusion of the foramen of Monro. She underwent endoscopic septostomy and widening of the foramen of Monro. Her headache subsided after surgery. At 15 months of follow-up, she was free from headache without medications. Unilateral occlusion of the foramen of Monro can present with asymmetric ventriculomegaly resulting in chronic headache. Though the symptoms of raised ICP may not be present, still endoscopic relief of ventriculomegaly leads to cure of headache.

Indigenous Inexpensive Practice Models for Skill Development in Neuroendoscopy

“…N euroendoscopy has become an important tool and is progressively increasingly used in cranial,[ 1 2 ] spinal,[ 3 4 5 ] and skull base[ 6 7 ] pathologies. One can use neuroendoscopy either as a solo modality in neurosurgery, such as endoscopic third ventriculostomy,[ 8 ] cerebrospinal fluid rhinorrhea,[ 9 ] pituitary surgeries,[ 7 ] craniopharyngioma,[ 10 ] colloid cyst,[ 2 ] hematoma evacuations, odontoid resection,[ 4 ] trigeminal neuralgia,[ 11 ] and surgery with the help of tubular retractor. [ 12 ] Neuroendoscopic techniques are associated with a tough learning curve.…”

Commentary

“…The authors present a report of chronic headaches[ 1 ] attributed to a stable unilateral occlusion of the left foramen of Monro (FM) that was followed for 5 years before surgical intervention (septostomy and foraminoplasty of the left FM) leading to dramatic clinical improvement. The patient's symptoms surprisingly resolved after surgery despite the recurrent membrane occlusion at the FM on follow-up imaging.…”