Late obstruction of an endoscopic third ventriculostomy stoma by metastatic seeding of a recurrent medulloblastoma.
Endoscopic third ventriculostomy (ETV) has been established as an effective method in the treatment of tumoral obstructive hydrocephalus. Delayed closure of the ETV stoma has been attributed to scarring involving the third ventricular floor. Secondary obstruction of the stoma due to intraventricular tumor seeding is an extremely rare condition, with only one case described to date. The authors report on a unique case of late closure of the ETV stoma caused by metastatic seeding of a recurrent medulloblastoma 9 years after the initial treatment. The patient was submitted to a second endoscopic procedure in which a reddish mass located just at the third ventricular floor was resected, leading to reopening of the previous ETV stoma. To the best of the authors' knowledge, this case is the first report of an ETV obstruction due to metastatic CSF seeding of a medulloblastoma. In such cases of late failure of the ETV stoma because of tumor obstruction, a second ETV can be safely performed and lead to adequate function of the stoma, even if limited by the aggressive nature of the disease.
Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil. flavionigri@gmail.com
Flávio
F
Nigri
Carlos
C
Telles
Marcus André
MA
Acioly
D000293:Adolescent; D000328:Adult; D002528:Cerebellar Neoplasms / Q000473:pathology* / Q000601:surgery*; D002555:Cerebrospinal Fluid / Q000166:cytology; D018450:Disease Progression; D017809:Fatal Outcome; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000473:pathology / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000473:pathology* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D009366:Neoplasm Seeding; D044583:Neuroendoscopy; D012086:Reoperation; D020542:Third Ventricle / Q000473:pathology* / Q000601:surgery*; D014696:Ventriculostomy; D055815:Young Adult