Neuroendoscopic third ventriculostomy in the management of fourth ventricular outlet obstruction

Acquired fourth ventricular outlet obstruction, an uncommon entity, has been conventionally managed by ventriculoperitoneal shunt placements or excision of the obstructing membranes. The role of endoscopic third ventriculostomy is highlighted in the present communication. Three patients presenting with symptoms of raised intracranial pressure were diagnosed to have fourth ventricular outlet obstruction by neuroimaging studies and underwent endoscopic third ventriculostomy. All the patients had relief of their symptoms in the postoperative period. Neuroimaging studies performed at follow-up revealed decrease in ventricular size in all. Endoscopic third ventriculostomy is a useful alternative in the management of acquired fourth ventricular outlet obstruction.