Endoscopic Monro Foraminoplasty, types, techniques and complications avoidance

Abstract

AimThis study aimed to unveil the proper selection of suitable pathologies eligible for foraminoplasty, types per surgical target, and avoidance of complications. MethodsOut of 3425 cranial endoscopic procedures performed through over a quarter of a century, in two Egyptian University Medical Centre, 250 cases subjected to “Endoscopic Monro Foraminoplasty (EMF)” were reviewed. Preoperative MRI T2 including coronal sequence were obtained. Solid lesions up to 2 cm above the foramen of Monro were considered for excision foraminoplasty. Dilatation and restoration foraminoplasty were performed using Fogarty balloon catheter. Combined EMF and pellucidotomy eliminated the need for bilateral foraminoplasty. Patients' age ranged from 3 months to 55 years, with a follow-up period of 2–12 years. ResultsTriventricular hydrocephalus with lateral ventricular asymmetry was in 45.2% of the cases, while bilateral foraminal occlusion with equal sized lateral ventricles were detected in 18.8%. Biventricular hydrocephalus was seen in 27.2% of patients. Biventricular hydrocephalus involved both lateral ventricles in 24% of cases while involvement of single lateral ventricle and the third ventricle contributed to 3.2% of cases. Unilateral hydrocephalus was reported in 8.8%%. Congenital bilateral pinhole stenosis was dilated in four infants. Foraminoplasty can be sorted into three types: Dilatation Foraminoplasty used to treat congenital (1.6%), idiopathic (6.4%) or post hemorrhagic/meningitic (15.6%) stenosis; Restoration Foraminoplasty used to fenestrate a membrane (12%) or cyst wall nearby the foramen (22%); and Excision Foraminoplasty for solid space-occupying lesions (SOL) (4%), partially cystic tumors (38.4%) may require combined aspiration and squeeze foraminoplasty especially in retro-foraminal colloid cysts with coapted foramen edges. The only reported -to this specific procedure-complication was transient remediable memory disturbance. ConclusionsEndoscopic Monro Foraminoplasty is a definitive neuroendoscopic treatment procedure. It deserves abbreviation assignment (EMF).