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Case Reports
. 2023 Dec 15:10:1257679.
doi: 10.3389/fsurg.2023.1257679. eCollection 2023.

Case Report: Occlusion of the foramen of Monro treated with endoscopic septostomy and foraminotomy in a preterm neonate

Po-Yu Lai  1 , Cheng-Hao Li  1 , Ming-Tao Yang  2   3 , Pao-Hui Feng  2 , Chi-Man Kuok  2
Affiliations
Case Reports

Case Report: Occlusion of the foramen of Monro treated with endoscopic septostomy and foraminotomy in a preterm neonate

Po-Yu Lai et al. Front Surg. .

Abstract

Background: Hydrocephalus is a brain abnormality frequently encountered in neonates. There are several known etiologies of hydrocephalus, which can be classified as either congenital or acquired. Occlusion of the foramen of Monro (FOM) is a cause of hydrocephalus and can be either congenital or secondary to various disorders. Idiopathic obstruction of the FOM presenting as prenatal ventriculomegaly is extremely rare but has been reported.

Case presentation: We present the case of a preterm newborn with severe bilateral hydrocephalus due to FOM occlusion in the prenatal period. Although the neonate had normal head circumference and no clinical symptoms after birth, brain sonography revealed progressive ventriculomegaly. Further image revealed bilateral ventriculomegaly with normal-sized third and fourth ventricles. We suspected a complete obstruction of the right and a partial obstruction of the left of the FOM. The neonate underwent endoscopic septostomy and foraminotomy, resulting in improvement.

Conclusion: We report a case of preterm FOM occlusion in the youngest and smallest neonate to date. Endoscopic septostomy and foraminotomy were performed in order to avoid ventriculoperitoneal shunt-related complications, highlighting the viability of endoscopic procedures which should be the primary treatment in preterm neonates with FOM occlusion.

Keywords: endoscope; foramen of Monro; foraminotomy; hydrocephalus; septostomy; sonography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Brain sonography. (A) Right sagittal view, (B) left sagittal view, and (C,D) the coronal plane, showing ventriculomegaly, especially at the right side (A).
Figure 2
Figure 2
Preoperative T2 fluid-attenuated inversion recovery (FLAIR) sequence in the transverse view (A) showing bilateral ventriculomegaly and contralateral shift of the septum pellucidum (arrow), and postoperative T2 FLAIR sequence transverse view (B) showing regressive change of right-sided ventriculomegaly.
Figure 3
Figure 3
Intraoperative image showing obstructed foramen of monro, which was fenestrated to connect the bilateral ventricles.
See this image and copyright information in PMC

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