{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:18:24Z","timestamp":1769728704047,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Occlusion of the foramen of Monro is an exceedingly rare condition in adults and can lead to obstructive hydrocephalus. The authors present the first reported case of biventricular hydrocephalus caused by tuberculosis-induced bilateral obstruction of the foramen of Monro. They also discuss the technical nuances and surgical challenges associated with this condition.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 47-year-old female presented with a 3-month history of short-term memory disturbances, ultimately leading to loss of consciousness. Neuroimaging revealed symmetrical biventricular hydrocephalus accompanied by periventricular interstitial edema. A lumbar puncture indicated lymphocytic-dominant pleocytosis and reduced glucose levels. During the endoscopic approach, significant stenosis of the foramen of Monro was noticed and monroplasty and septostomy were performed. Pathological examination revealed granulomatous inflammation. At the 1-year follow-up, the patient demonstrated significant clinical and radiological improvement, with resolution of symptoms and hydrocephalus.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Tuberculosis-induced bilateral idiopathic occlusion of the foramen of Monro is an extremely uncommon cause of hydrocephalus. Neuroendoscopy allows for visualization, biopsy, and direct treatment of the obstruction simultaneously. While conservative management may be adequate for asymptomatic cases, neuroendoscopic procedures such as septostomy or foraminoplasty provide a minimally invasive option for restoring CSF flow, avoiding unnecessary shunt insertion in symptomatic cases.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25349<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25349","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:49:02Z","timestamp":1756770542000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical management of biventricular hydrocephalus caused by tuberculosis-induced bilateral obstruction of the foramen of Monro: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Kaveh","family":"Ebrahimzadeh","sequence":"first","affiliation":[{"name":"Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4799-7229","authenticated-orcid":true,"given":"Mohammad","family":"Mirahmadi Eraghi","sequence":"additional","affiliation":[{"name":"Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran"},{"name":"Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Hallajnejad","sequence":"additional","affiliation":[{"name":"Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9010-8239","authenticated-orcid":true,"given":"Seyed Taher","family":"Mousavian","sequence":"additional","affiliation":[{"name":"Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0895-4261","authenticated-orcid":true,"given":"Mohammad","family":"Ansari","sequence":"additional","affiliation":[{"name":"Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahram","family":"Sabeti","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"11","key":"bib1","series-title":"Acta Neurochir (Wien)","first-page":"2109","article-title":"Hidden aqueductal stenosis associated to bilateral idiopathic foramina of Monro stenosis mimicking a Chiari I malformation? Case report","volume":"154","author":"Bartoli","year":"2012","unstructured":"Bartoli AGhinda CDRadovanovic IMomjian S.Hidden aqueductal stenosis associated to bilateral idiopathic foramina of Monro stenosis mimicking a Chiari I malformation? Case report. Acta Neurochir (Wien). 2012;154(11):2109-2113."},{"key":"bib2","series-title":"J Clin Neurosci","first-page":"140","article-title":"Idiopathic bilateral occlusion of the foramen of Monro: an unusual entity with varied clinical presentations","volume":"34","author":"Mizrahi","year":"2016","unstructured":"Mizrahi CJCohen JEGomori JMShoshan YSpektor SMoscovici S.Idiopathic bilateral occlusion of the foramen of Monro: an unusual entity with varied clinical presentations. J Clin Neurosci. 2016;34:140-144."},{"issue":"2","key":"bib3","series-title":"J Neurosurg","first-page":"246","article-title":"Third ventricular choroid plexus arteriovenous malformation simulating a colloid cyst: case report","volume":"52","author":"Britt","year":"1980","unstructured":"Britt RHSilverberg GDEnzmann DRHanbery JW.Third ventricular choroid plexus arteriovenous malformation simulating a colloid cyst: case report. J Neurosurg. 1980;52(2):246-250."},{"issue":"4","key":"bib4","series-title":"Neurosurgery","first-page":"664","article-title":"Unilateral hydrocephalus caused by an intraventricular venous malformation obstructing the foramen of Monro","volume":"26","author":"Tien","year":"1990","unstructured":"Tien RHarshGR IVDillon WPWilson CB.Unilateral hydrocephalus caused by an intraventricular venous malformation obstructing the foramen of Monro. Neurosurgery. 1990;26(4):664-666."},{"key":"bib5","series-title":"Acta Radiol Diagn (Stockh)","first-page":"310","article-title":"Occult hydrocephalus due to ectasia of the basilar artery","volume":"9","author":"Greitz","year":"1969","unstructured":"Greitz TEkbom KKugelberg EBreig A.Occult hydrocephalus due to ectasia of the basilar artery. Acta Radiol Diagn (Stockh). 1969;9:310-316."},{"issue":"5","key":"bib6","series-title":"Br J Neurosurg","first-page":"1319","article-title":"Idiopathic membranous occlusion of the foramen of Monro: an unusual cause of hydrocephalus and headache in adults","volume":"37","author":"Chin","year":"2023","unstructured":"Chin XSMorgenstern PFBelani PB.Idiopathic membranous occlusion of the foramen of Monro: an unusual cause of hydrocephalus and headache in adults. Br J Neurosurg. 2023;37(5):1319-1321."},{"key":"bib7","series-title":"World Neurosurg","first-page":"e610","article-title":"Endoscopic strategy in surgical treatment of adult idiopathic bilateral occlusion of the foramen of Monro and review of the literature","volume":"115","author":"Ebrahimzadeh","year":"2018","unstructured":"Ebrahimzadeh KMaloumeh ENSamadian MRezaei O.Endoscopic strategy in surgical treatment of adult idiopathic bilateral occlusion of the foramen of Monro and review of the literature. World Neurosurg. 2018;115:e610-e619."},{"issue":"4","key":"bib8","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy","volume":"30","author":"Kalhorn","year":"2011","unstructured":"Kalhorn SPStrom RGHarter DH.Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy. Neurosurg Focus. 2011;30(4):E5."},{"issue":"3","key":"bib9","series-title":"Neuroradiology","first-page":"275","article-title":"Congenital constriction of the foramen of Monro","volume":"28","author":"Marions","year":"1986","unstructured":"Marions OBoethius J.Congenital constriction of the foramen of Monro. Neuroradiology. 1986;28(3):275-278."},{"issue":"4","key":"bib10","series-title":"J Infect","first-page":"330","article-title":"Hydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis","volume":"66","author":"Raut","year":"2013","unstructured":"Raut TGarg RKJain AHydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis. J Infect. 2013;66(4):330-337."},{"issue":"4","key":"bib11","series-title":"Neurol India","first-page":"368","article-title":"Management of hydrocephalus in patients with tuberculous meningitis","volume":"57","author":"Rajshekhar","year":"2009","unstructured":"Rajshekhar V.Management of hydrocephalus in patients with tuberculous meningitis. Neurol India. 2009;57(4):368-374."},{"issue":"1","key":"bib12","series-title":"Surg Neurol","first-page":"51","article-title":"Adult \u201ccongenital\u201d bilateral occlusion of the foramina of Monro","volume":"37","author":"Maxwell","year":"1992","unstructured":"Maxwell JAStimac GK.Adult \u201ccongenital\u201d bilateral occlusion of the foramina of Monro. Surg Neurol. 1992;37(1):51-53."},{"issue":"18","key":"bib13","series-title":"Neurology","first-page":"e166","article-title":"Mystery case: idiopathic bilateral stenosis of the foramina of Monro","volume":"79","author":"Raz","year":"2012","unstructured":"Raz EFatterpekar GDavis AJHuang PPLoh JP.Mystery case: idiopathic bilateral stenosis of the foramina of Monro. Neurology. 2012;79(18):e166-e167."},{"issue":"2","key":"bib14","series-title":"Neurol Med Chir (Tokyo)","first-page":"81","article-title":"Neuroendoscopic treatment of idiopathic occlusion of the foramen of Monro in adults. Two case reports","volume":"42","author":"Freudenstein","year":"2002","unstructured":"Freudenstein DDuffner FKrapf HWagner AGrote EH.Neuroendoscopic treatment of idiopathic occlusion of the foramen of Monro in adults. Two case reports. Neurol Med Chir (Tokyo). 2002;42(2):81-85."},{"issue":"2","key":"bib15","series-title":"J Neurosurg","first-page":"416","article-title":"Endoscopic stent placement for treatment of secondary bilateral occlusion of the Monro foramina following endoscopic third ventriculostomy in a patient with aqueductal stenosis: case report","volume":"107","author":"Mori","year":"2007","unstructured":"Mori HKoike TFujimoto TNishiyama KYoshimura JTanaka R.Endoscopic stent placement for treatment of secondary bilateral occlusion of the Monro foramina following endoscopic third ventriculostomy in a patient with aqueductal stenosis: case report. J Neurosurg. 2007;107(2):416-420."},{"key":"bib16","series-title":"Clin Neurol Neurosurg","first-page":"108279","article-title":"Adult idiopathic bilateral occlusion of foramen of Monro: systematic review with illustrative case","volume":"241","author":"Hernandez","year":"2024","unstructured":"Hernandez MALULegaspi EDCKhu KJO.Adult idiopathic bilateral occlusion of foramen of Monro: systematic review with illustrative case. Clin Neurol Neurosurg. 2024;241:108279."},{"issue":"11","key":"bib1","series-title":"Acta Neurochir (Wien)","first-page":"2109","article-title":"Hidden aqueductal stenosis associated to bilateral idiopathic foramina of Monro stenosis mimicking a Chiari I malformation? Case report","volume":"154","author":"Bartoli","year":"2012","unstructured":"Bartoli AGhinda CDRadovanovic IMomjian S.Hidden aqueductal stenosis associated to bilateral idiopathic foramina of Monro stenosis mimicking a Chiari I malformation? Case report. Acta Neurochir (Wien). 2012;154(11):2109-2113."},{"key":"bib2","series-title":"J Clin Neurosci","first-page":"140","article-title":"Idiopathic bilateral occlusion of the foramen of Monro: an unusual entity with varied clinical presentations","volume":"34","author":"Mizrahi","year":"2016","unstructured":"Mizrahi CJCohen JEGomori JMShoshan YSpektor SMoscovici S.Idiopathic bilateral occlusion of the foramen of Monro: an unusual entity with varied clinical presentations. J Clin Neurosci. 2016;34:140-144."},{"issue":"2","key":"bib3","series-title":"J Neurosurg","first-page":"246","article-title":"Third ventricular choroid plexus arteriovenous malformation simulating a colloid cyst: case report","volume":"52","author":"Britt","year":"1980","unstructured":"Britt RHSilverberg GDEnzmann DRHanbery JW.Third ventricular choroid plexus arteriovenous malformation simulating a colloid cyst: case report. J Neurosurg. 1980;52(2):246-250."},{"issue":"4","key":"bib4","series-title":"Neurosurgery","first-page":"664","article-title":"Unilateral hydrocephalus caused by an intraventricular venous malformation obstructing the foramen of Monro","volume":"26","author":"Tien","year":"1990","unstructured":"Tien RHarshGR IVDillon WPWilson CB.Unilateral hydrocephalus caused by an intraventricular venous malformation obstructing the foramen of Monro. Neurosurgery. 1990;26(4):664-666."},{"key":"bib5","series-title":"Acta Radiol Diagn (Stockh)","first-page":"310","article-title":"Occult hydrocephalus due to ectasia of the basilar artery","volume":"9","author":"Greitz","year":"1969","unstructured":"Greitz TEkbom KKugelberg EBreig A.Occult hydrocephalus due to ectasia of the basilar artery. Acta Radiol Diagn (Stockh). 1969;9:310-316."},{"issue":"5","key":"bib6","series-title":"Br J Neurosurg","first-page":"1319","article-title":"Idiopathic membranous occlusion of the foramen of Monro: an unusual cause of hydrocephalus and headache in adults","volume":"37","author":"Chin","year":"2023","unstructured":"Chin XSMorgenstern PFBelani PB.Idiopathic membranous occlusion of the foramen of Monro: an unusual cause of hydrocephalus and headache in adults. Br J Neurosurg. 2023;37(5):1319-1321."},{"key":"bib7","series-title":"World Neurosurg","first-page":"e610","article-title":"Endoscopic strategy in surgical treatment of adult idiopathic bilateral occlusion of the foramen of Monro and review of the literature","volume":"115","author":"Ebrahimzadeh","year":"2018","unstructured":"Ebrahimzadeh KMaloumeh ENSamadian MRezaei O.Endoscopic strategy in surgical treatment of adult idiopathic bilateral occlusion of the foramen of Monro and review of the literature. World Neurosurg. 2018;115:e610-e619."},{"issue":"4","key":"bib8","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy","volume":"30","author":"Kalhorn","year":"2011","unstructured":"Kalhorn SPStrom RGHarter DH.Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy. Neurosurg Focus. 2011;30(4):E5."},{"issue":"3","key":"bib9","series-title":"Neuroradiology","first-page":"275","article-title":"Congenital constriction of the foramen of Monro","volume":"28","author":"Marions","year":"1986","unstructured":"Marions OBoethius J.Congenital constriction of the foramen of Monro. Neuroradiology. 1986;28(3):275-278."},{"issue":"4","key":"bib10","series-title":"J Infect","first-page":"330","article-title":"Hydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis","volume":"66","author":"Raut","year":"2013","unstructured":"Raut TGarg RKJain AHydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis. J Infect. 2013;66(4):330-337."},{"issue":"4","key":"bib11","series-title":"Neurol India","first-page":"368","article-title":"Management of hydrocephalus in patients with tuberculous meningitis","volume":"57","author":"Rajshekhar","year":"2009","unstructured":"Rajshekhar V.Management of hydrocephalus in patients with tuberculous meningitis. Neurol India. 2009;57(4):368-374."},{"issue":"1","key":"bib12","series-title":"Surg Neurol","first-page":"51","article-title":"Adult \u201ccongenital\u201d bilateral occlusion of the foramina of Monro","volume":"37","author":"Maxwell","year":"1992","unstructured":"Maxwell JAStimac GK.Adult \u201ccongenital\u201d bilateral occlusion of the foramina of Monro. Surg Neurol. 1992;37(1):51-53."},{"issue":"18","key":"bib13","series-title":"Neurology","first-page":"e166","article-title":"Mystery case: idiopathic bilateral stenosis of the foramina of Monro","volume":"79","author":"Raz","year":"2012","unstructured":"Raz EFatterpekar GDavis AJHuang PPLoh JP.Mystery case: idiopathic bilateral stenosis of the foramina of Monro. Neurology. 2012;79(18):e166-e167."},{"issue":"2","key":"bib14","series-title":"Neurol Med Chir (Tokyo)","first-page":"81","article-title":"Neuroendoscopic treatment of idiopathic occlusion of the foramen of Monro in adults. Two case reports","volume":"42","author":"Freudenstein","year":"2002","unstructured":"Freudenstein DDuffner FKrapf HWagner AGrote EH.Neuroendoscopic treatment of idiopathic occlusion of the foramen of Monro in adults. Two case reports. Neurol Med Chir (Tokyo). 2002;42(2):81-85."},{"issue":"2","key":"bib15","series-title":"J Neurosurg","first-page":"416","article-title":"Endoscopic stent placement for treatment of secondary bilateral occlusion of the Monro foramina following endoscopic third ventriculostomy in a patient with aqueductal stenosis: case report","volume":"107","author":"Mori","year":"2007","unstructured":"Mori HKoike TFujimoto TNishiyama KYoshimura JTanaka R.Endoscopic stent placement for treatment of secondary bilateral occlusion of the Monro foramina following endoscopic third ventriculostomy in a patient with aqueductal stenosis: case report. J Neurosurg. 2007;107(2):416-420."},{"key":"bib16","series-title":"Clin Neurol Neurosurg","first-page":"108279","article-title":"Adult idiopathic bilateral occlusion of foramen of Monro: systematic review with illustrative case","volume":"241","author":"Hernandez","year":"2024","unstructured":"Hernandez MALULegaspi EDCKhu KJO.Adult idiopathic bilateral occlusion of foramen of Monro: systematic review with illustrative case. 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