Use of Grotenhuis perforator in endoscopic third ventriculostomy and cyst fenestration

We performed a retrospective review of consecutive patients at our institution who underwent endoscopic third ventriculostomy (E3V) or fenestration of intraventricular cysts using the Grotenhuis endoscopic perforator. The procedure was performed on 23 patients between 2001 and 2006, and included 20 E3Vs and three intraventricular cyst fenestrations. The Grotenhuis perforator was effective in accomplishing a fenestration with multiple attempts. When the floor of the third ventricle was translucent, the perforator was effective with the least amount of effort. The instrument was less effective and additional instruments were necessary in patients with arachnoid cysts or when the floor of the third ventricle was thick. The main advantage in using the Grotenhuis perforator was in displacing the floor of the third ventricle away from the basilar artery during perforation. No basilar artery injury or other serious complications occurred in patients who underwent E3V or cyst fenestration using the Grotenhuis perforator.