Fenestration Of Symptomatic Ventriculus Terminalis: 2-Dimensional Operative Video

This is a case of a 73 yr-old female presenting with low back pain and bilateral sciatic pain, which progressed to bilateral lower extremity weakness about 1 yr after initial presentation. Imaging of her thoraco-lumbar spine revealed a ventriculus terminalis extending from the level of the eleventh thoracic vertebra (T11) to the first lumbar vertebra (L1). Ventriculus terminalis is an embryological ependymal lined cavity that normally regresses with development. In individuals with persistent ventriculus terminalis, it is usually incidentally noted during spine imaging for other purposes. Surgery is seldom indicated except for patients presenting with progressive neurological deficits. Patient was taken to surgery for fenestration of the ventriculus and decompression of the spinal canal. The patient was positioned prone, and after proper localization the vertebral column was exposed through a midline approach and a central laminectomy was performed from T11-L1. Intraoperative monitoring was used throughout the procedure. This video illustrates the gross appearance of a ventriculus terminalis, dissection of surrounding neural elements, and decompression of the ventriculus using a wide fenestration technique.  All relevant patient identifiers have been removed from the video. Nevertheless, patient consent was obtained regarding video recording and redistribution of procedure for educational purposes.