Traumatic subependymal hematoma during endoscopic third ventriculostomy ina patient with a third ventricle tumor: Case report

Endoscopic third ventriculostomy has become a routine intervention for the treatment of non-communicating hydrocephalus. This technique is largely con sidered safe and a very low incidence of complications is reported. However , hemorrhage in the course of neuroendoscopy is still a problem difficult t o manage. The authors present a case in which endoscopic third ventriculost omy and tumor biopsy were performed in a young patient with a huge tumor gr owing in the posterior part of the third ventricle. The surgical approach t o realize the stoma was difficult because the tumor size reduced the third ventricle diameter. Surgical manipulation produced a traumatic subependymal hematoma. This hematoma drained spontaneously after few minutes into the v entricle and the blood was washed away. The postoperative neurological cour se was uneventful and the ventriculostomy showed to work well by reducing t he size of the lateral ventricles and the intracranial pressure in three da ys. This complication during endoscopic third ventriculostomy has never bee n reported before. We emphasize the difficulty of endoscopic procedures in patients with huge tumors in the third ventricle. Where reduction in size o f the third ventricle and of the foramen of Monro ist present we suggest a careful approach to the third ventricle.