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Retrograde Third Ventriculocisternostomy From the Posterior Fossa

Yanamadala, Vijay MD; Walcott, Brian P. MD; Nahed, Brian V. MD; Barker, Fred G. II MD

doi: 10.1227/NEU.0b013e3182744b67
Operative Technique

BACKGROUND: Postoperative hydrocephalus is common in patients after resection of a posterior fossa tumor, with as many as 25% of patients requiring permanent cerebrospinal fluid diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent postoperative hydrocephalus.

OBJECTIVE: To define the technique of microsurgical retrograde third ventriculostomy from the posterior fossa.

METHODS: The operative technique is described and a single patient with 4-year follow-up is reported.

RESULTS: We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern via a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision.

CONCLUSION: Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent cerebrospinal fluid diversion and in whom exposure of the interpeduncular cistern is available.

ABBREVIATIONS: ETV, endoscopic third ventriculocisternostomy

RTV, retrograde third ventriculocisternostomy

VS, ventricular shunting

Neurosurgical Service, Massachusetts General Hospital, Department of Surgery (Neurosurgery), Harvard Medical School, Boston, Massachusetts

Correspondence: Brian P. Walcott, MD, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114. E-mail:

Received September 05, 2012

Accepted September 14, 2012

Copyright © by the Congress of Neurological Surgeons