Hydrocephalus caused by metastatic brain lesions: treatment by third ventriculostomy

Metastasis to the brain occurs in 20%–40% of cancer patients.1 About 20% of these metastases are located in the posterior fossa, cerebellum, and brainstem. Metastatic disease to periventricular brain tissue can obstruct the flow of cerebrospinal fluid (CSF) produced in the ventricles to the subarachnoid space where it is normally absorbed by arachnoid granulations. This typically causes an obstructive or non-communication hydrocephalus. A shunt has been customarily placed to drain CSF from a lateral ventricle through a pressure regulating valve and into the atrium or peritoneal or pleural cavity. Even though this technique has been successful in relieving the hydrocephalus, it has about a 50% chance of infection or failure from blockage.2 Another option for the treatment of obstructive hydrocephalus is third ventriculostomy, a minimal invasive endoscopic neurosurgical procedure. In performing third ventriculostomy, a hole is created in the floor of the third ventricle, allowing CSF inside the ventricle to drain out to the CSF space surrounding …