Traumatic Subependymal Hematoma During Endoscopic Third Ventriculostomy in a Patient with a Third Ventricle Tumor: Case Report

Endoscopic third ventriculostomy has become a routine intervention for the treatment of non-communicating hydrocephalus. This technique is largely considered safe and a very low incidence of complications is reported. However, hemorrhage in the course of neuroendoscopy is still a problem difficult to manage. The authors present a case in which endoscopic third ventriculostomy and tumor biopsy were performed in a young patient with a huge tumor growing in the posterior part of the third ventricle. The surgical approach to realize the stoma was difficult because the tumor size reduced the third ventricle diameter. Surgical manipulation produced a traumatic subependymal hematoma. This hematoma drained spontaneously after few minutes into the ventricle and the blood was washed away. The postoperative neurological course was uneventful and the ventriculostomy showed to work well by reducing the size of the lateral ventricles and the intracranial pressure in three days. This complication during endoscopic third ventriculostomy has never been reported before. We emphasize the difficulty of endoscopic procedures in patients with huge tumors in the third ventricle. Where reduction in size of the third ventricle and of the foramen of Monro ist present we suggest a careful approach to the third ventricle.

Key words:

Subependymal Hematoma - Neuroendoscopy - Third Ventriculostomy - Third Ventricle Tumors

References

• 1 Buxton N. Neuroendoscopic third ventriculostomy.  Neurosurg Focus. 1999;  6 (4) Article 2
• 2 Oka K. et al . Endoneurosurgical treatment for hydrocephalus caused by intraventricular tumors.  Childs Nerv Syst. 1994;  10 162-166
• 3 Jones R FC, Brazier D H, Kwok B CT. et al .Neuroendoscopic third ventriculostomy. In: Cohen AR, Haines SJ (eds): Minimally Invasive Techniques in Neurosurgery Baltimore: Williams & Wilkins 1995: 33-48
• 4 Pierre Kahn A, Renier D, Bombois B. et al . Place de la ventriculo-cisternostomie dans le traitment des hydrocephalies non communicantes.  Neurochirurgie. 1975;  21 557-569
• 5 Sayers M P, Kosnik E J. Percutaneous third ventriculostomy: experience and technique.  Childs Brain. 1976;  2 24-30
• 6 Kobata H, Kondo A, Iwasaki K, Hattori I. Massive subependymal hemorrhage caused by an occult vascular malformation two cases report.  Neurol Med Chir. 1999;  39 (4) 302-307
• 7 Yamamoto M, Oka K, Takasugi S, Hachisuka S, Miyake E, Tomonaga M. Flexible neuroendoscopy for percutaneous treatment of intraventricular lesions in the absence of hydrocephalus.  Minim Invasive Neurosurg. 1997;  40 (4) 139-143
• 8 Karasawa J, Kikuchi H, Furuse S. Subependimal hematoma in “Moyamoya” disease.  Surg Neurol. 1980;  13 (2) 118-120
• 9 McLaughlin M R, Wahlig J B, Kaufmann A M. et al . Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report.  Neurosurgery. 1997;  41 1400-1404
• 10 Grant J A, Mc Lone D G. Third ventriculostomy: a review.  Surg Neurol. 1997;  47 210-212
• 11 Schroeder H W, Warzok R W, Assaf J A, Gaab M R. Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy. Case report.  J Neurosurg. 1999;  90 (1) 153-155
• 12 Handler M H, Abbott R, Lee M. A near fatal complication of endoscopic third ventriculostomy: case report.  Neurosurgery. 1994;  35 525-528
• 13 Hopf N J, Grunert P, Fries G, Resh K D, Perneczky A. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 (4) 795-806
• 14 Manwaring K H, Crone K R. Neuroendoscopy. Vol I ed Mary Ann Liebert Inc
• 15 Schmidt R H. Use of a microvascular Doppler probe to avoid basilar artery injury during endoscopic third ventriculostomy. Technical note.  Neurosurg. 1999;  90 (1) 156-159

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