ENDOSCOPIC STOMY OF THE SEPTUM PELLUCIDUM : INDICATIONS, TECHNIQUE, AND RESULTS

Although endoscopic perforation of the septum pellucidum in obstruction of the foramen of Monro is well known, detailed reports on endoscopic septostomy, including surgical technique and results are lacking in the literature. All intracranial endoscopic procedures performed between February 1993 and March 2008 were evaluated. All patients with blockage of the foramen of Monro that was treated with endoscopic septostomy were analyzed and prospectively followed. Particular attention was given to indications, approach, surgical technique, complications, and results. Thirty-two endoscopic septostomies were performed in 30 patients (17 male patients, 13 female patients; mean age, 31 years; age range, 4 months-68 years). Cerebrospinal fluid circulation was obstructed by tumor (16 cases), multiloculated cystic hydrocephalus (8 cases, including 2 revisions), septum pellucidum cysts (3 cases), membranous or inflammatory isolated lateral ventricles (3 cases), and giant aneurysms (2 cases). Simultaneously with septostomy, 13 endoscopic tumor procedures, 9 endoscopic third ventriculostomies, and 9 other endoscopic procedures were performed. The mean surgical time was 80 minutes (range, 45-135 minutes). There were 4 asymptomatic complications (13%), 5 transient complications (16%), and no permanent complications. Postoperatively, 26 patients (87%) improved. Two revisions had to be performed. The mean follow-up period was 16 months (range, 1-93 months). On the basis of the results, long-standing cerebrospinal fluid circulation restoration can be achieved with endoscopic septostomy. Endoscopic septostomy is a safe and reliable endoscopic technique that should be considered more frequently for the restoration of cerebrospinal fluid circulation in the treatment of blockage of the foramen of Monro.