Endoscopic ventriculostomy

Patients most likely to benefit from third ventriculostomy should have noncommunicating hydrocephalus and a preservation of the communication between the subarachnoid space and the venous system
- indicated in aqueductal stenosis, pineal or thalamic tumor, obstruction of the aqueduct, acquired obstruction of the 4th ventricle
- older age in children is associated with improved outcome
technique: endoscope is guided through the foramen of Monro into the third ventricle; landmarks include the mamillary bodies at the posterior aspect of the floor of the third venticle, the infundibular and optic recess anteriorly, the thin translucent tuber cinereum is identified anterior to the mammillary bodies; site of fenestration must be far enough anterior to avoid trauma to the basilar artery and its apical branches; floor of third ventricle is punctured with a probe or Bugby wire and enlarged with a balloon