Endoscopic third ventriculostomy has become a routine intervention for the treatment
of non-communicating hydrocephalus. This technique is largely considered safe and
a very low incidence of complications is reported. However, hemorrhage in the course
of neuroendoscopy is still a problem difficult to manage. The authors present a case
in which endoscopic third ventriculostomy and tumor biopsy were performed in a young
patient with a huge tumor growing in the posterior part of the third ventricle. The
surgical approach to realize the stoma was difficult because the tumor size reduced
the third ventricle diameter. Surgical manipulation produced a traumatic subependymal
hematoma. This hematoma drained spontaneously after few minutes into the ventricle
and the blood was washed away. The postoperative neurological course was uneventful
and the ventriculostomy showed to work well by reducing the size of the lateral ventricles
and the intracranial pressure in three days. This complication during endoscopic third
ventriculostomy has never been reported before. We emphasize the difficulty of endoscopic
procedures in patients with huge tumors in the third ventricle. Where reduction in
size of the third ventricle and of the foramen of Monro ist present we suggest a careful
approach to the third ventricle.
Subependymal Hematoma - Neuroendoscopy - Third Ventriculostomy - Third Ventricle Tumors
