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Endoscopic third ventriculostomy

Endoscopy is a very good surgical option for obstructive hydrocephalus. It avoid the need of placing a shunt and its associated complications and morbidity.
This patient presented with raised intracranial pressure due to fourth ventricular outlet obstruction causing obstructive hydrocephalus. He underwent endoscopic third ventriculostomy. The endoscope was inserted into the third ventricle, passed through the foramen of Monroe. Fogarthy's catheter was used to make a stoma in the floor of the third ventricle.
Patient had an eneventful recovery. Follow up CT scan showed resolution of hydrocephalus.

T2W axial image with dilatation of ventricles

Pre-op sagittal image shows dilatation of the fourth ventricle with fourth ventricular outlet obstruction

Follow up CT scan with resolution of hydrocephalus and normal fourth ventricle

Endoscope in the frontal horn of the lateral ventricle

Floor of third ventricle

Fogarthy's catheter used for ventriculostomy

Pre-pontine cistern seen after perforation of the floor of the third ventricle