Endoscopic treatment of adult idiopathic obstruction of the foramen of Monro

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Adult idiopathic membranous obstruction of the foramen of Monro is an extremely rare condition that can be effectively treated with endoscopic foraminoplasty. A unilateral or bilateral foraminoplasty is performed if one or both of the foramina of Monro are obstructed, respectively. Endoscopic septum pellucidotomy is usually used in combination with the foraminoplasty.


The operative chart and video of one of our patients undergoing endoscopic treatment for adult idiopathic membranous obstruction of the foramen of Monro were retrieved from our database and reviewed. A description of the surgical technique was then formulated.


The surgical technique of endoscopic foraminoplasty plus septum pellucidotomy for adult idiopathic membranous obstruction of the foramen of Monro is described.

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Construction interference in steady state


Cerebrospinal fluid


Computed tomography


External ventricular drainage


Fast imaging employing steady-state acquisition


Magnetic resonance imaging


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Correspondence to Waleed A. Azab.

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Key points

1. Endoscopic foraminoplasty with or without septum pellucidotomy is a minimally invasive technique.

2. The procedure is indicated in cases with membranous obstruction of the foramen of Monro.

3. In cases with idiopathic obstruction of the foramen of Monro, preoperative MR imaging studies may fail to reveal obstructing membranes found during endoscopy.

4. The procedure should replace shunting and microsurgical foraminoplasty as an initial treatment modality.

5. The morbidity of the procedure is less than that of shunting and microsurgical excision.

6. The procedure is performed through one or two burr holes based on whether one or two foramina of Monro are obstructed.

7. The technique of endoscopic foraminoplasty varies according to the pathoanatomy of the foraminal obstruction and septal deviation.

8. Although bilateral foraminoplasty is the ideal strategy when both foramina are obstructed, a unilateral foraminoplasty plus a septum pellucidotomy may be sufficient as a CSF diversion diversion.

9. The procedure requires a high level of experience in intraventricular neuroendoscopy.

10. Shunting should be resorted to in cases of failed endoscopic foraminoplasty.

Electronic supplementary material

Surgical technique of endoscopic foraminoplasty and septum pellucidotomy (WMV 116568 kb)

Video 1

Surgical technique of endoscopic foraminoplasty and septum pellucidotomy (WMV 116568 kb)

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Azab, W.A., Alsheikh, T.M., Elmansoury, T.M. et al. Endoscopic treatment of adult idiopathic obstruction of the foramen of Monro. Acta Neurochir 159, 1439–1443 (2017) doi:10.1007/s00701-017-3246-5

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  • Adult
  • Endoscopic
  • Foramen of Monro
  • Foraminoplasty
  • Idiopathic
  • Membranous