Male patient, fruit of first pregnancy of a 33-year-old woman.
The pregnancy had passed without incidents, with screening of the first trimester of low risk.
Usual serological studies were normal.
The antenatal ultrasound detected dilation of the right lateral ventricle at 37 weeks of gestational age, without other morphological abnormalities to be highlighted.
The patient was born at 39+3 weeks of gestational age, with instrumented vaginal delivery.
The presentation was ceftazidime and his Apgar score of 9-9-10.
Examination after delivery showed good tone and vitality; spontaneous anterior normal-tension anomalies, with no morphological highlight or dysraphism.
Archaic advantage present.
Analytical and serological studies, screening for dementia and deafness were normal.
Normal eye fundus Echocardiography showed atrial septal defect with no hemodynamic repercussion.
Transfontanellar ultrasound showed dilation of the right lateral ventricle, probably related to obstruction of the right foramen of Monro.
At this time, the resistance index of the pericallosal artery was within normal limits, without increasing after exerting pressure on the anterior chamber.
One week after birth, a brain magnetic resonance imaging (MRI) confirmed ventricular dilation with a caliber of 8 mm from the frontal horn, 32 mm from the occipital horn and 14 mm from the temporal horn.
It was associated with a displacement of 4 mm from the midline, without observing intraventricular masses or septa.
The rest of the ventricular system was normal.
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Due to the absence of intracranial hypertension data and the age of the patient, initial clinical and radiological follow-up was decided by serial ultrasound.
At 10 weeks of age, transfontanellar ultrasound showed increased dilation (frontal loop 11 mm, occipital 27 mm and temporal 19 mm), displacement of 6 mm of the line mid-phalangeal artery and increased pressure index posterior.
Although the patient presented normal perimeter and normal clinical examination, surgical treatment of hydrocephalia was decided.
The patient underwent surgery at 3 months of age.
A rigid ventriculus was used at 0o (Kart Sz®, Tuttlingen, Germany).
Under general anesthesia, the patient was placed in a supine position, with an elevated neutral head about 20o.
A right truss hole was made just anterior to the coronal suture and 3 cm lateral to the midline.
Access to the ventricle was performed following the usual anatomical references, directing the end to the inner corner of the ipsilateral eye in the coronal plane and toward the external auditory canal in the sagittal plane.
After accessing the right frontal horn, the ventricular anatomy was identified and the theoretical location of the foramen of Monro was located following the thalamo-striatal and anterior septal veins and the choroid plexus.
An avascular membrane was identified through which the foramen of Monro was intuited by transparency.
Coagulation and subsequent opening of this membrane were performed using the bipolar tip and then spread with a 4 French Fogarty balloon.
Through the new ventricle created, the apex was visualized.
After creating an adequate communication of the right frontal horn with the third ventricle, fenestration of the anterior septum pelum was performed in order to ensure another communication pathway between the lateral frontal horns of the ventricles.
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The patient's postoperative course was uneventful.
The evolution of the cranial perimeter and the physical and neurological examination in the first 6 months of follow-up were normal.
Transfontanellar ultrasound monitoring showed improvement in right lateral ventricle dilation, with normal pericallose artery index.
MRI performed at 9 months of age confirmed these ultrasound findings.
