title: Nontraumatic aneurysm rupture following an endoscopic third ventriculostomy and ventricular drainage: Case report of a rare complication.
abstract: BACKGROUND
  Although endoscopic third ventriculostomy is a safe procedure, the authors report a case of aneurysmal subarachnoid hemorrhage as an unusual and serious complication of an endoscopic third ventriculostomy and ventricular drainage.
  
  
  METHODS
  A 60-year-old male presented with obstructive hydrocephalus caused by midbrain tumors was admitted to our hospital. Endoscopic third ventriculostomy and external ventricular drainage were successfully performed. Two days after the operation, he became comatose, and a computed tomography (CT) scan revealed a diffuse subarachnoid hemorrhage. Emergency cerebral angiogram showed an aneurysm of the left internal carotid artery. Endovascular coil embolization of the ruptured aneurysm was then performed.
  
  
  CONCLUSIONS
  The rupture of the aneurysm may have been induced by excessive cerebrospinal fluid drainage after the endoscopic third ventriculostomy. Planning for intracranial endoscopic procedures should consider that rupture of an unknown previously unruptured aneurysm is a possible complication.
authors.affiliation: Department of Neurosurgery, Nakagami Hospital, Okinawa, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyagi
authors.affiliation: Uchikado Neuro-Spine Clinic, Fukuoka, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Uchikado
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Takachika
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Sakata
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Hirohata
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
keywords: Complication; endoscopic third ventriculostomy; obstructive hydrocephalus; subarachnoid hemorrhage; ventricular drainage