# Radiosurgical Septostomy: A Technical Report of Two Cases

## TL;DR

Radiosurgical septostomy is a minimally invasive treatment for asymmetric hydrocephalus, successfully used in two patients with meningioma.

## Contribution

This paper introduces radiosurgical septostomy as a novel, effective treatment for asymmetric hydrocephalus.

## Key findings

- Radiosurgical septostomy led to symptomatic and imaging improvement in both patients.
- MRI showed reduced ventricular dilation over long-term follow-up.
- The procedure was safe with no complications or treatment failures.

## Abstract

Septostomy is a surgical procedure in which a hole or fenestration is created in the septum pellucidum, a thin membrane between the brain’s lateral ventricles. Here, we describe radiosurgical septostomy as an alternative to the treatment of asymmetric hydrocephalus. We report the cases of two males, 46 years old and 64 years old, diagnosed with meningioma and asymmetric hydrocephalus. Brain MRI and cranial CT showed a left lateral hydrocephalus in both cases. Both patients underwent a radiosurgical septostomy on the TrueBeam STX platform. The target used was the septum pellucidum on its avascular portion. The prescribed doses were 120 Gy and 100 Gy, respectively. After radiosurgical septostomy, symptomatic and imaging improvement was noted. MRI showed a reduction in ventricular dilation over a long follow-up period. There were no treatment failures or complications with the procedure. Radiosurgical septostomy is a minimally invasive, highly precise, secure, and effective treatment modality.