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Spontaneous third ventriculocisternostomy in an infant with obstructive hydrocephalus

Case report

Gary L. Gallia and Charles Teo

✓Spontaneous ventriculocisternostomy, the spontaneous communication between the ventricular system and the subarachnoid space, is rare. The authors report a case of an infant with obstructive hydrocephalus who developed a spontaneous third ventriculocisternostomy. The infant was initially evaluated for progressive ventriculomegaly and increasing head circumference (HC). During follow-up, the patient's HC began to follow percentile lines and magnetic resonance (MR) imaging demonstrated a reduction of the hydrocephalus. Flow-sensitive phase-contrast cine MR images revealed cerebrospinal fluid (CSF) flow through the floor of the third ventricle between the tuber cinereum and the mammillary bodies connecting the ventricular system with the prepontine cistern. Although rare, clinicians should be cognizant of this phenomenon as it may eliminate the need for CSF diversion.

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The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications

Brian J. Dlouhy, Michael P. Chae, and Charles Teo


The supraorbital eyebrow approach utilizes an eyebrow skin incision to fashion a supraorbital craniotomy for exposure of the subfrontal corridor. This provides anterolateral access to surgical lesions in the anterior cranial fossa, parasellar regions, brainstem, and medial temporal lobe. With use of the endoscope, further areas can be accessed. This approach has been applied effectively in adults, but questions remain about its use in children—specifically with regard to adequate working space, effectiveness for achieving the desired results, cosmesis, and complications.


The authors conducted a retrospective review of more than 450 cases involving patients of all ages who had undergone a supraorbital eyebrow approach performed by the senior author (C.T.) from 1995 to 2013. Only cases involving patients younger than 18 years with a minimum follow-up of 6 weeks were included in this study. All inpatient and outpatient records were retrospectively reviewed and clinical/operative outcomes, cosmetic results, and complications were recorded. In the present article, the authors briefly describe the surgical approach and highlight any differences in applying it in children.


Fifty-four pediatric patients who had undergone a supraorbital eyebrow approach met inclusion criteria. The pathological conditions consisted mostly of tumors or other resectable lesions. In a total of 51 resectable lesions, 44 surgeries resulted in a gross-total (100%) resection and 7 cases resulted in subtotal (50%–99%) resection. The endoscope assisted and expanded visualization or provided access to areas not reached by standard microscopic visualization in all cases. Cosmetic outcomes were excellent. In all cases, the incisional scar was barely visible at 6 weeks. In 3 cases a minor bone defect was observed on the forehead. Given the small size of the frontal sinus in children, no frontal sinus breaches occurred. Additionally, no CSF leak or wound infection was identified.


The supraorbital eyebrow approach is extremely effective in achieving desired results in properly selected cases in patients of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.