Fourteen out of 16 patients had septum pellucidum fenestrations. 4. Illustrative Cases 4.1. Patient 13 (Arachnoid Cyst) (See Video 1 in the Supplementary Material Available Online at http://dx.doi.org/10.1155/2013/471805) A 35-year-old patient with no previous history of headaches presented with selleck chemical one month of progressive severe headaches. A CT scan, followed by an MRI of the brain, demonstrated a right lateral ventricle arachnoid cyst and associated ventriculomegaly of the right lateral ventricle. After three months of conservative medical management, the patient’s headaches were persistent and associated with dizzy spells. A repeat MRI demonstrated unchanged findings of the right lateral ventricle arachnoid cyst and associated ventriculomegaly.

The patient elected to proceed with a neuroendoscopic exploration and potential resection of her arachnoid cyst. With the variable aspiration tissue resector, the arachnoid cyst capsule was drawn into the side cutting aperture from the ependymal surface and partially resected, permitting reestablishment of CSF flow. The patient was discharged on postoperative day four without incident. Postoperative MRI demonstrated a reduction in ventricular size, and this remained stable at three-month follow-up (Figure 2). The patient had resolution of her severe presenting headaches. Figure 2 Patient 1, lateral ventricle arachnoid cyst. Preoperative ((a) and (c)) and postoperative ((b) and (d)) contrast enhanced axial T1-weighted magnetic resonance imaging, demonstrating decompression of the cyst and lateral ventricles. 4.2.

Patient 14 (Pilocytic Astrocytoma) (Video 2) Patient 14 is a 20-year-old female who woke up the day of presentation with a severe headache. Both CT and MR images (Figure 3) were obtained revealing a left lateral ventricular lesion extending from the hypothalamic region. The patient was initially alert but became lethargic requiring EVD placement. The patient underwent a subtotal resection of her pilocytic astrocytoma with the variable aspiration tissue resector through the working channel endoscope (Figure 3). The patient’s EVD was weaned successfully on post-operative day four, and she was discharged home on post-operative day seven, neurologically intact. Figure 3 Patient 14, pilocytic astrocytoma. ((a) and (b)) Preoperative coronal T1-weighted contrast-enhanced magnetic resonance imaging showing enhancing lesion and obstructive hydrocephalus. (c) Decrease in ventricular size with interval debulking of lesion. … 4.3. Patient 15 (Large Colloid Cyst) (Video 3) Patient 15 was a 20-year-old male presenting with progressive headache two days following an episode of transient confusion and word-finding difficulty. CT scan of the head demonstrated a 2.3cm third ventricular cystic Cilengitide lesion.