Abstract
Background Obstructive hydrocephalus caused by vertebrobasilar dolichoectasia is an extremely
rare entity. Cerebrospinal fluid pathway obstruction may be localized at the level
of either the foramina of Monro or the cerebral aqueduct. Radiological imaging can
sometimes be misleading in establishing the precise location of the obstruction, which
is crucial in determining the optimal surgical strategy. We report such a case with
diagnostic challenges and also present a review of previously reported cases with
a special focus on diagnostic and therapeutic controversies.
Case Description We present a patient with an obstructive hydrocephalus associated with a dolichoectatic
basilar artery extending to the level of the foramina of Monro. Although computed
tomography angiography findings indicate bilateral occlusion of the foramina of Monro
by the posterior cerebral arteries, mild but suspicious dilatation of the third ventricle
raised concerns about the precise location of the obstruction. Endoscopic exploration
of the right foramen of Monro was performed not only to clarify questionable radiological
findings but also to be prepared to make a septostomy prior to monoventriculoperitoneal
shunting if exploration would confirm occlusion of the foramina of Monro. However,
the right foramen of Monro was documented to be patent during surgery and the cerebral
aqueduct was considered to be the location of obstruction. The procedure was accomplished
with monoventriculoperitoneal shunting, which achieved a full recovery immediately
after the operation.
Conclusions Our current experience and the literature review highlight the usefulness of neuroendoscopy
as a diagnostic and therapeutic solution, particularly in cases considered to have
obstructive hydrocephalus caused by compression of the foramina of Monro by dolichoectatic
basilar artery.
Keywords
cerebral aqueduct - endoscopy - obstructive hydrocephalus - vertebrobasilar dolichoectasia
