title: Adult idiopatic occlusion of Monro foramina: intraoperative endoscopic reinterpretation of radiological data and review of the literature.
abstract: Adult idiopathic occlusion of the foramen of Monro (AIOFM) is a rare condition, with only few cases described in the modern literature. We propose that AIOFM may result from unilateral or bilateral occlusion of Monro foramina, as well as from progression of a monolateral hydrocephalus. Different surgical strategies may be required for effective treatment according to the type of occlusion. To date, only 12 cases of AIOFM have been reported in the literature. We report the cases of two patients, aged 20 and 47 years respectively, who presented with intracranial hypertension secondary to bilateral ventricular dilatation due to obstruction at the level of the foramen of Monro. Both patients were successfully treated with endoscopic fenestration of the primarily obstructed foramen of Monro and, in one patient, fenestration of the septum. We propose that septum pellucidum displacement could play a role in the occlusion of the second foramen of Monro. AIOFM can, therefore, result also from unilateral stenosis of Monro. The difference in AIOFM (i.e. unilateral vs bilateral) will be useful in guiding the most suitable surgical approach in this rare condition.
authors.affiliation: Neurosurgical Unit, Santa Maria delle Grazie Hospital , Pozzuoli, Naples , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Schonauer
authors.forename: Reuben
authors.initials: R
authors.lastname: Johnson
authors.forename: Stefano
authors.initials: S
authors.lastname: Chiriatti
authors.forename: Raffaele
authors.initials: R
authors.lastname: de Falco
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Albanese
authors.forename: Enrico
authors.initials: E
authors.lastname: Tessitore
authors.forename: Giuseppe M V
authors.initials: GM
authors.lastname: Barbagallo
mesh_terms: D000328:Adult; D002552:Cerebral Ventricles / Q000473:pathology* / Q000601:surgery*; D014695:Cerebral Ventriculography; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D012688:Septum Pellucidum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Foramen of Monro; MRI; foraminoplasty; neuroendoscopy; septum pellucidum; thulium laser