Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy - Case report

In recent years, endoscopic third ventriculostomy has become a well-establi shed procedure for the treatment of various forms of noncommunicating hydro cephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachno id hemorrhage (SAH) after endoscopic third ventriculostomy. This 63-year-old man presented with confusion and drowsiness and was admitt ed in to the hospital in poor general condition. Computerized tomography sc anning revealed an obstructive hydrocephalus caused by a tumor located in t he cerebellopontine angle. An endoscopic third ventriculostomy was performe d with the aid of a Fogarty balloon catheter. Some hours postoperatively, t he patient became comatose. Computerized tomograhy scanning revealed a seve re perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours late r. Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complic ations may occur. To avoid Vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the in fundibular recess and the mammillary bodies, just behind the dorsum sellae.