Controversial neuroendoscopic Monro foraminoplasty in the management of isolated lateral ventricle in an adult

This report describes the clinical presentation, differential diagnosis, imaging characteristics, and current literature regarding the minimally invasive neuroendoscopic treatment of a rare condition: idiopathic unilateral hydrocephalus presenting late in adulthood. This paper also addresses the current controversy regarding septum pellucidotomy and/or Monro foraminoplasty as mono- or dual therapies for UH. A 63 year old African American female presented with headaches, blurry vision, and gait instability for six months. She was referred for neurosurgical consultation after an MRI demonstrated enlargement of the right lateral ventricle with left septal deviation. The patient underwent endoscopic transventricular fenestration of an idiopathic membrane occluding the foramen of Monro, as well as foraminoplasty of the foramen of Monro and septum pellucidotomy. Postoperatively the patient had transient difficulty with short term recall that improved rapidly, and she was discharged home on postoperative day 2. Follow-up one month later demonstrated complete resolution of her headache, blurry vision, and imbalance, as well as continued improvement of her memory. At six months, she had durable resolution of hydrocephalus and no short term memory complaints