Neuroendoscopic third ventriculostomy in the management of noncommunicating hydrocephalus secondary to giant basilar artery bifurcation aneurysm - case report and review of literature.

Recently neuroendoscopic third ventriculostomy has become a well-established procedure for the treatment of noncommunicating hydrocephalus. However, morphological changes of the third ventricular floor can make endoscopic fenestration technically difficult, and increase the risk of injury to the basilar artery and perforators. The risk is especially high in patients with basilar artery bifurcation aneurysms, in whom aneurysm exclusion should precede treatment of hydrocephalus. If definitive aneurysm treatment is impossible or hazardous, endoscopic septostomy or shunting may be beneficial. However, reduction of intracranial hypertension may induce aneurysmal growth and rupture. We report upon a case of obstructive hydrocephalus produced by a non-ruptured partially thrombosed giant basilar artery bifurcation aneurysm, in which definitive treatment was considered impossible, successfully treated with neuroendoscopic third ventriculostomy. To the authors' knowledge this is the first reported case of its kind. The authors conclude that in similar cases neuroendoscopic ventriculostomy is worth trying if anatomical landmarks are identifiable.