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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(03): 651-655
DOI: 10.1055/s-0045-1809052
Case Report

Endoscopic Third Ventriculostomy in a Child with Tectal Glioma and Extremely Diminished Prepontine Interval

Mohammad Elbaroody
1   Department of Neurosurgery, Cairo University, Cairo, Egypt
,
Mahmoud Talaat Shafiey
1   Department of Neurosurgery, Cairo University, Cairo, Egypt
,
Wally Hesham Moemen
1   Department of Neurosurgery, Cairo University, Cairo, Egypt
,
Ehab El Refaee
1   Department of Neurosurgery, Cairo University, Cairo, Egypt
2   Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
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Funding None.
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Abstract

Diminished prepontine interval is a challenging intraoperative finding that creates an additional risk while doing an endoscopic third ventriculostomy (ETV) due to the proximity of the basilar artery to the ventriculostomy site. It is not a contraindication for the procedure especially in patients with thinned floors through which the vascular structures can be easily visualized and it was not proven to be a risk factor for failure of the procedure. Old children with hydrocephalus secondary to tectal glioma have a high chance of successful ETV, thus avoiding shunt dependency. A 12-year-old male patient presented with headache and grade III papilledema, magnetic resonance imaging brain revealed tectal glioma and triventricular hydrocephalus. He underwent a successful ETV despite a challenging intraoperative, extremely diminished prepontine interval. At 1-year follow-up, brain imaging showed a complete resolution of hydrocephalus and stationary course for the tectal glioma. The present case highlights that diminished prepontine interval is not a contraindication for doing ETV unless safety cannot be guaranteed, and it was not proven to be a risk factor for ETV failure. Creating a stoma on the dorsum sellae after palpating the bone or just behind it using blunt fenestration is a safe way especially in the presence of a thinned third ventricle floor with clearly visualized vascular structures.

Keywords

dorsum sellae - endoscopic third ventriculostomy - ETV - hydrocephalus - prepontine interval - tectal glioma

Authors' Contributions

M.E. contributed to concepts, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, and manuscript review. M.T., W.M., and E.E. helped in the design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, and manuscript review. M.T. and W.M. were involved in data collection and manuscript preparation. All the authors approved the manuscript before submission.


Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments.


Patients' Consent

Informed consent to participate and for publication was obtained from all individual participants included in the study. Written informed consent was obtained from the parents as legal guardians.




Publication History

Article published online:
08 May 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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