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Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty

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Abstract

Object

One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature.

Methods

A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted.

Results

In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies.

Conclusion

Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.

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Data availability

All data have been acquired from the database of our Hospital.

Code availability

Not Applicable.

Abbreviations

CT :

Computed Tomography

MRI :

Magnetic Resonance Image

FM :

Foramen of Monro

F :

French

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Funding

No funding was received to assist with the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain

    José Javier Guil-Ibáñez, Mario Gomar-Alba, Fernando García-Pérez, Leandro Saucedo, José María Narro-Donate, Antonio José Vargas-López, Ascensión Contreras-Jiménez & José Masegosa-González

  2. Department of Health Science, University of Almería, Almería, Spain

    José Javier Guil-Ibáñez, Mario Gomar-Alba, Antonio José Vargas-López, Tesifón Parrón-Carreño & Gracia M. Castro-Luna

  3. Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain

    Mario Gomar-Alba & Antonio José Vargas-López

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  1. José Javier Guil-Ibáñez
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  2. Mario Gomar-Alba
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Contributions

Guil-Ibañez JJ: Conception, data gathering, writing, and production.

Gomar-Alba M; García-Pérez F; Saucedo L; Narro-Donate JM; Vargas-López AJ; Parrón-Carreño T; Castro-De Luna GM; Contreras Jiménez A; Masegosa-González J;: Reviewers.

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Correspondence to José Javier Guil-Ibáñez.

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All procedures performed in the studies involving human participants were in accordance with ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

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Guil-Ibáñez, J.J., Gomar-Alba, M., García-Pérez, F. et al. Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty. Acta Neurochir 166, 197 (2024). https://doi.org/10.1007/s00701-024-06077-z

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