pellucidum was fenestrated to allow visualization of the contralateral ventricle and interventricular foramen, both of which appeared normal. The skin was closed over the burr hole site. A head CT scan obtained on postoperative day 1 showed interval decrease of the size of the right ventricle with near resolution of the calcifications along the tract ( Fig. 3C ). The patient had no postoperative complications and had stable imaging findings 3 years postoperatively ( Fig. 3D ). DiscussionNeuroendoscopyhas demonstrated safety and efficacy in the treatment of a host of

V entricularneuroendoscopyrepresents an important advance in the treatment of hydrocephalus. About 30% of patients with hydrocephalus meet the criteria for this technique, which may prevent the need for a ventriculoperitoneal shunt, resulting in reduced costs and low incidence of late complications. 4 , 5 , 6 , 7 , 12 , 15 , 17 Nonetheless, because a ventricular endoscope is used through a single bur hole, additional resources to enable cutting, coagulation, and ablation of injuries are extremely relevant to reduce surgical time and hospital length of

treatment using a flexible endoscope. 4 We present, to our knowledge, the first report of a single frontal burr hole being used for flexibleneuroendoscopyto provide initial treatment of obstructive hydrocephalus and a fourth ventricular arachnoid cyst in a pediatric patient. We include an annotated intraoperative video ( Video 1 ) describing our technique, a review of the literature via a single database search exploring treatment of all reported fourth ventricular arachnoid cysts, and discussion of special considerations when using this approach, to help instruct and

hole flexibleneuroendoscopyfor ETV and biopsy and showcase a novel reappropriation of urological biopsy forceps to complement a flexible neuroendoscopic approach. Illustrative Case A healthy 13-year-old male presented with morning headaches and emesis for 4 weeks. Brain computed tomography demonstrated triventricular enlargement with transependymal flow. Magnetic resonance imaging revealed a contrast-enhancing cystic lesion of the tectal region, compressing and occluding the cerebral aqueduct and resulting in obstructive hydrocephalus ( Fig. 1 ). FIG. 1

postoperative care and maintenance; this procedure therefore does not limit patients in their future activities, which might be of particular importance in younger and pediatric populations. 30 In the CWD procedure, the posterior semicircular canal is removed, resulting in improved visualization of the disease and the affected middle ear anatomy. 30 This technical note describes an alternative method for removal of a recurrent petrous apex cholesteatoma in a 14-year-old girl via a retrosigmoid approach using the techniques of piezoelectric surgery,neuroendoscopy, and

A dvances in neuroendoscope technology have changed the ability to visualize and navigate the ventricular system. Consequently, these tools have helped to expand our realm of surgical techniques in the treatment of pathologies such as hydrocephalus. Rigidneuroendoscopyhas been in use since the early 1900s, by L’Espinasse and Dandy, whereas flexibleneuroendoscopywas not introduced until the 1970s by Fukushima. 1 Both of these modalities have been used in performing endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization