title: Dual-trajectory Approach for Simultaneous Cyst Fenestration and Endoscopic Third Ventriculostomy for Treatment of a Complex Third Ventricular Arachnoid Cyst.
abstract: OBJECTIVE
  We present a case of a multiloculated third ventricular arachnoid cyst to describe a novel technique for definitive management of these lesions via direct endoscopic fenestration and CSF diversion utilizing separate trajectories that offers superior visualization and avoids forniceal injury.
  
  
  RESULTS
  We present a case of a 33-year-old woman with progressive headache and worsened vision, a known history of a multiloculated third-ventricular arachnoid cyst, and imaging findings consistent with cyst expansion and worsened obstructive hydrocephalus. We then describe the dual-trajectory approach for simultaneous cyst fenestration and endoscopic third ventriculostomy that ultimately resulted in successful treatment of her cyst and hydrocephalus.
  
  
  CONCLUSIONS
  Dual-trajectory endoscopic approach utilizing double burr holes should be considered when addressing lesions of the third ventricle causing obstructive hydrocephalus.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Ho
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center.
authors.forename: Arjun V
authors.initials: AV
authors.lastname: Pendharkar
authors.affiliation: Department of Neurosurgery, Stanford School of Medicine/Stanford University Medical Center.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Sussman
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Ravikumar
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Li
keywords: arachnoid cyst; burrhole; endoscopic third ventriculostomy; hydrocephalus; image guidance