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Failure to treat obstructive hydrocephalus with endoscopic third ventriculostomy in a patient with neurodegenerative Langerhans cell histiocytosis

Case report

Amir Kershenovich, Angela V. Price, Korgun Koral, Stan Goldman, and Dale M. Swift

sampling of the thickened infundibular recess ependyma and right fornix column, which had abnormal anatomical conformation ( Fig. 2 ). F ig . 2. Intraoperative endoscopic view of the right lateral ventricle. From right to left : thalamostriate vein, foramen of Monro, choroid plexus, and septal vein. Note the abnormal nodular tissue at the fornix column, between 9 and 12 o'clock in the foramen of Monro. First Postoperative Course The biopsy sample appeared to be a yellow to grayish semi-translucent tissue. After filtering and sectioning, the specimen

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Minimally invasive endoscopic transventricular hemispherotomy for medically intractable epilepsy: a new approach and cadaveric demonstration

Laboratory investigation

Biji Bahuleyan, Sunil Manjila, Shenandoah Robinson, and Alan R. Cohen

-forward rod lens was inserted. The image was transmitted to a high-definition video monitor using a microchip camera, and photographs were taken. White matter disconnections were created using a blunt probe or microscissors, which were inserted through a working channel in the endoscope sheath. The surgical steps followed in our technique were similar to those in the vertical parasagittal hemispherotomy popularized by Delalande et al. 2 , 3 These steps consisted of corpus callosotomy, temporal horn unroofing, frontobasal disconnection, and fornix disconnection. The

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Forniceal glioma in children

Clinical article

Thomas Blauwblomme, Pascale Varlet, John R. Goodden, Marie Laure Cuny, Helene Piana, Thomas Roujeau, Federico DiRocco, Jacques Grill, Virginie Kieffer, Nathalie Boddaert, Christian Sainte-Rose, and Stéphanie Puget

function. 1 , 2 , 4–6 We report a series of 8 children treated in the Hôpital Necker Enfants Malades, Paris, over a 17-year period. Their presentation, disease management, histological and radiological features, and outcomes are described. Methods We performed a retrospective analysis of all children who were treated surgically at Hôpital Necker for supratentorial glioma between 1990 and 2007. There were 250 patients, with only 8 having lesions involving the fornix. We excluded large tumors from other locations with forniceal extension. Histological findings

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Transcavum interforniceal endoscopic surgery of the third ventricle

Clinical article

Mark M. Souweidane, Caitlin E. Hoffman, and Theodore H. Schwartz

These publications have justifiably focused on patients with normal intraventricular anatomy. Through such experience, the endoscopic surgeon has come to rely on the familiarity of the foramen of Monro with its surrounding structures of the choroid plexus, columns of the fornix, and septal and thalamostriate veins for safe transforaminal navigation into the third ventricle. An increasing reliance on endoscopic surgery in the third ventricle will demand that predictable anatomical variants are described with respect to the pertinent anatomy and their respective

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Letter to the Editor

Endoscopic septostomy for headache

Jeffrey E. Florman

331 : 376 – 382 , 2005 10.1136/bmj.38512.405440.8F 3 Ozturk A , Yousem DM , Mahmood A , El Sayed S : Prevalence of asymmetry of mamillary body and fornix size on MR imaging . AJNR Am J Neuroradiol 29 : 384 – 387 , 2008 10.3174/ajnr.A0801

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Sudden intraaqueductal dislocation of a third ventricle ependymoma causing acute decompensation of hydrocephalus

Case report

Christian Rosenstengel, Jörg Baldauf, Jan-Uwe Müller, and Henry W. S. Schroeder

required only 1 bur hole located approximately 2 cm in front of the coronal suture, to access both the floor of the third ventricle and the posterior part of the third ventricle. On the MR images obtained prior to the surgery, we saw a large foramen of Monro, which allowed a tilting of the endoscope within the foramen to visualize the ventricle floor and entry of the aqueduct. Of course there is a risk of damaging sensitive structures such as ependymal veins or the fornix during this maneuver. However, with careful insertion and slow movements of the scope, the risk

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Editorial: Hypothalamic hamartomas

Harold L. Rekate

significant roles. The approach presented here by Roth et al. 2 is a hybrid between the transcallosal interforniceal approach and a purely endoscopic transventricular approach. The procedure is analogous to the “endoscopic assisted” surgical procedures advocated by contemporary skull base surgeons. There is no need to separate the columns of the fornix, which theoretically would make this procedure less likely to lead to severe difficulties with short-term memory than the transcallosal interforniceal approach, since you begin by entering the lateral ventricle. Depending

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Colloid cyst of velum interpositum: a rare finding

Case report

Tom C. Morris and Stephen Santoreneos

C olloid cysts of the third ventricle are an uncommon clinical entity, with patients on average presenting in their 2nd–4th decade of life. The lesions usually arise from the anterior portion of the roof of the third ventricle, located between the columns of the fornix at the foramina of Monro. It has been suggested that these cysts derive from the nondegenerated rudiments of the embryonic paraphysis, although their exact germline derivation remains a debate. 3 The cysts' classic imaging appearance is due to the thick proteinaceous fluid that they contain

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Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles

Clinical article

Hideki Ogiwara and Nobuhito Morota

considered difficult. 8 , 22 Paraventricular structures, such as the fornix, thalamus, or deep ventricular veins, can be damaged by inaccurate cannulation or moving the endoscope through insufficient working space. Recently, 2 articles reported the feasibility of endoscopic tumor management in small ventricles using a rigid endoscope in adult and pediatric populations. 18 , 28 In this article, we aimed to evaluate the effectiveness and safety of a flexible endoscope for management of intraventricular brain tumors in patients without ventriculomegaly. With regard to

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A management strategy for intraventricular subependymal giant cell astrocytomas in tuberous sclerosis complex

Clinical article

David H. Harter, Luigi Bassani, Shaun D. Rodgers, Jonathan Roth, Orrin Devinsky, Chad Carlson, Jeffery H. Wisoff, and Howard L. Weiner

a small portion of tumor remains adherent, particularly when calcified, it is left. The caudate vein is usually stretched over the tumor, and occasionally encased; we have attempted to preserve it. The smaller septal vein is usually displaced medially, and is easily separable from the tumor. Identification and preservation of the fornix are also important; we try to identify it early in the dissection, and protect it with a cottonoid patty throughout. Lastly, the choroid plexus is usually displaced superiorly, and may be coagulated and divided with impunity