Diabetes insipidus after endoscopic third ventriculostomy. A case report and review of the literature

Endoscopic third ventriculostomy has been found to be successful for treati ng occlusive hydrocephalus. The complication rate ranges from 6 to 12 %. In traoperative bleeding is the most common incident. Endocrinological failure s are rare, mainly due to the proximity of the hypothalamic structures. We report the case of a 33-year-old man who was referred in emergency for s ubacute hydrocephalus related to a tentorium meningioma. The hydrocephalus was treated by endoscopic third ventriculostomy. During the procedure, the floor of the third ventricle was found to be thick but fenestration was per formed without incident. After surgery, the clinical signs of hydrocephalus disappeared but diabetes insipidus was diagnosed the same day. There were no other endocrinology disorders. Medical treatment with vasopressin allowe d resolution of the diabetes insipidus in fifteen days. Surgical debulking of the meningioma was then achieved via a subtemporal approach. There was n o recurrence of the endocrinology disorder. Diabetes insipidus is an unpredictable complication of third ventriculostom y. The mechanism is not well known. It is however a transient disorder that can easily be treated with vasopresin and therefore should not modify the indications of third ventriculostomy, especially in tumor-related hydroceph alus.