Neuroendoscopic management of posterior third ventricle ependymoma with intraaqueductal and fourth ventricle extension: a case report and review of the literature

Childs Nerv Syst. 2017 Nov;33(11):2057-2060. doi: 10.1007/s00381-017-3543-6. Epub 2017 Jul 18.


Introduction: Posterior third ventricle ependymomas with intraaqueductal extension are relatively infrequent lesions. Its surgical management represents a formidable technical challenge and includes a wide variety of approaches. Minimally invasive surgery including the endoscopic management can play a crucial role to obtain an optimal clinical outcome.

Patients and methods: We report the clinical outcome of an 11-year-old female patient with a 6-year history of recurrent episodes of headache and vomiting. On brain MRI a posterior third ventricle lesion with extension to the aqueduct of Sylvius and fourth ventricle, and associated hydrocephalus was observed.

Results: Our management of the lesion included a two-step endoscopic surgery: first an anterior third ventriculostomy and biopsy of the lesion that was reported to be a low-grade ependymoma, and posteriorly an endoscopic-assisted resection of the lesion. Clinical outcome was optimal without neurological sequelae. The postoperative MRI showed a thickened ependymal area on the tumor base of implantation. It was considered to be a remnant of the lesion and subsequently treated with radiotherapy.

Conclusion: Posterior third ventricle ependymomas with intraaqueductal extension can be endoscopically managed to obtain a successful outcome.

Keywords: Aqueduct of Sylvius; Endoscopic; Ependymoma; Third ventricle.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Cerebral Aqueduct / pathology
  • Cerebral Aqueduct / surgery
  • Cerebral Ventricle Neoplasms / pathology
  • Cerebral Ventricle Neoplasms / surgery*
  • Child
  • Ependymoma / pathology
  • Ependymoma / surgery*
  • Female
  • Fourth Ventricle / pathology
  • Fourth Ventricle / surgery
  • Humans
  • Neuroendoscopy / methods*
  • Third Ventricle / pathology
  • Third Ventricle / surgery*