title: Microsurgical third ventriculostomy with stenting in intrinsic brain tumors involving anterior third ventricle.
abstract: OBJECTIVE
  Microsurgical fenestration of the third ventricular floor performed in one session with resection of deep seated tumors has been recently demonstrated as an approach to specifically address the concomitant obstructive hydrocephalus. As with endoscopic third ventriculostomy, occlusion of the stoma may result in progression of the obstructive hydrocephalus. In order to provide reliable communication between the basal cisterns and ventricles, we propose stenting of the stoma in cases of direct surgical approach to deep seated tumors.
  
  
  METHODS
  After performing tumor resection through the anterior transcallosal approach, premamillar and Liliequist's membranes were identified and fenestrated. A silicon stent was inserted into the prepontine cistern through the fenestrated floor of the third ventricle; the stent connected the third and lateral ventricles with the basal cisterns.
  
  
  RESULTS
  Microsurgical ventriculostomy of the third ventricle and stenting of the stoma was performed in 9 patients simultaneously with tumor resection (5 cases), open biopsy (3 cases), or microsurgical dissection of severe adhesions at the level of Monro foramina (1 case). In 7 cases, the third ventricular floor was infiltrated with the tumor and obstruction of the aqueduct persisted after tumor surgery; in 2 patients, high risk of reocclusion at the level of Monro foramen was expected. Stenting of the ventricular system provided patency of the stoma and Monro foramen. None of the patients required a shunt postoperatively. The follow-up time ranged from 3 to 22 months.
  
  
  CONCLUSIONS
  Microsurgical fenestration of the third ventricle floor combined with stoma stenting can be a viable option for hydrocephalus control.
authors.affiliation: Burdenko Neurosurgery Institute, Moscow, Russia. davnsi@mail.ru
authors.forename: David I
authors.initials: DI
authors.lastname: Pitskhelauri
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Konovalov
authors.forename: Dmitry N
authors.initials: DN
authors.lastname: Kopachev
authors.forename: Dmitry I
authors.initials: DI
authors.lastname: Samborsky
authors.forename: Tatiana V
authors.initials: TV
authors.lastname: Melnikova-Pitskhelauri
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D002946:Cisterna Magna / Q000601:surgery; D003337:Corpus Callosum / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000473:pathology; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D010871:Pinealoma / Q000150:complications / Q000601:surgery; D011149:Pons / Q000601:surgery; D015607:Stents; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*; D055815:Young Adult