• Ricardo Prat-Acín, Rocío Evangelista, Rebeca Conde, Angel Ayuso-Sacido, and Inma Galeano.
• Department of Neurosurgery, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46026, Valencia, Spain. ricprat@hotmail.com.
• Childs Nerv Syst. 2017 Nov 1; 33 (11): 2057-2060.

IntroductionPosterior third ventricle ependymomas with intraaqueductal extension are relatively infrequent lesions. Its surgical management represents a formidable technical challenge and includes a wide variety of approaches. Minimally invasive surgery including the endoscopic management can play a crucial role to obtain an optimal clinical outcome.Patients And MethodsWe report the clinical outcome of an 11-year-old female patient with a 6-year history of recurrent episodes of headache and vomiting. On brain MRI a posterior third ventricle lesion with extension to the aqueduct of Sylvius and fourth ventricle, and associated hydrocephalus was observed.ResultsOur management of the lesion included a two-step endoscopic surgery: first an anterior third ventriculostomy and biopsy of the lesion that was reported to be a low-grade ependymoma, and posteriorly an endoscopic-assisted resection of the lesion. Clinical outcome was optimal without neurological sequelae. The postoperative MRI showed a thickened ependymal area on the tumor base of implantation. It was considered to be a remnant of the lesion and subsequently treated with radiotherapy.ConclusionPosterior third ventricle ependymomas with intraaqueductal extension can be endoscopically managed to obtain a successful outcome.

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