Adult idiopathic bilateral occlusion of foramen of Monro: Systematic review with illustrative case

• Published in: Clinical neurology and neurosurgery 2024-06, Vol.241, p.108279-108279, Article 108279
• Main Authors: Hernandez, Mary Angeline Luz U., Legaspi, Eric Dennis C., Khu, Kathleen Joy O.
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Adult-onset foramen of Monro occlusion; Case reports; Catheters; Cerebral Ventricles - diagnostic imaging; Cerebral Ventricles - surgery; Congenital diseases; Constriction, Pathologic - surgery; Convulsions & seizures; Cysts; Decision making; Endoscopy; Female; Headaches; Hemorrhage; Humans; Hydrocephalus; Hydrocephalus - surgery; Idiopathic bilateral foramen of Monro occlusion; Infections; Intracranial pressure; Literature reviews; Male; Medical imaging; Middle Aged; Occlusion; Pathology; Patients; Pneumonia; Seizures; Stenosis; Systematic review; Ventriculoperitoneal Shunt; Young Adult
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108279

Adult idiopathic occlusion of foramen of Monro (AIOFM) is a rare condition that results in hydrocephalus, and bilateral presentation is even rarer. Here we report a case of idiopathic bilateral stenosis of the foramen of Monro in an adult patient and performed a systematic literature review on the current treatment options and outcomes. We performed a systematic review of SCOPUS, Science Direct, and PubMed databases in accordance with PRISMA guidelines. Data on demographics, clinical presentation, imaging findings, type of AIOFM, treatment, and outcomes were collected. A total of 22 cases of bilateral AIOFM were identified in the literature, including ours. The median age was 38.5 years (range: 20–53), with no sex predilection. The most common presenting symptoms were headache (n=16, 73%) and vomiting (n=10, 45%). There were 9 cases of Type 1 AIOFM (stenosis) and 13 cases of Type 2 (membrane occlusion). Majority of patients underwent surgical treatment, mostly endoscopic unilateral foraminoplasty and septostomy (59%), followed by ventriculoperitoneal shunt insertion (31%). One patient underwent medical management only to alleviate her presenting symptoms (seizures). The overall outcome was good for majority of patients at a median follow-up of 6 months. Bilateral AIOFM is a rare condition that may easily be missed, so neurosurgeons should be cognizant of this disease entity. Identification of the type of AIOFM may guide surgical decision-making. Treatment options include neuroendoscopic procedures such as septostomy and foraminoplasty, and ventriculoperitoneal shunt insertion. •AIOFM is a rare condition that may easily be missed, so neurosurgeons should be cognizant of this disease entity.•Adult idiopathic bilateral occlusion of the foramina of Monro into four types [4].•Identifying the type of AIOFM with cranial MRI may guide the neurosurgeon in selecting the best management.•Treatment options include neuroendoscopic procedures such as septostomy and foraminoplasty, and VP shunt insertion.