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Background We present an unusual but possible complication after ETV for the treatment of acute hydrocephalus due to malfunction of a previously implanted V-P shunt. Case Description A 12-year-old male patient was urgently operated upon by means of an endoscopic third-ventriculostomy and the positioning of a temporary external ventricular catheter because of the malfunction of a previously implanted V-P shunt; immediately after the operation, the tip of the external catheter caused an obstruction of the ostomy, which was resolved with the withdrawn of catheter for circa 1 cm, left closed and ultimately removed after 4 days. The patient did not present any further symptom and remained shunt-free at the last 2-year follow-up visit. Conclusions One should consider such occurrence in cases of early ETV failure when a ventricular catheter is left in situ, even though temporarily.

Objective: This study aims to provide morphometric analysis of endoscopic endonasal approach (EEA) to ventral-medial portion of posterior paramedian skull base (VMPPSB). Furthermore, it aims to investigate the surgical exposure obtained through EEA with and without Eustachian tube (ET) removal, emphasizing the role of contralateral nostril (CN) access. Methods: Five fresh adult head specimens were prepared for dissection. A pre-dissection and a post-dissection CT study was performed. A surgically oriented classification into 4 regions was used: 1) tubercular region; 2) occipital condyle region; 3) parapharyngeal space (PPhS) region; 4) jugular foramen (JF) region. Student's t-test was used to compare angulations and measures of EEA with access from the ipsilateral and CN, respectively with and without ET removal. Results: EEA to VMPPSB encompasses two medial trajectories (transtubercular and transcondylar) and two lateral pathways to PPhS and JF. The CN access, without removal of ET, allows a complete exposure of petrous and intrajugular portion of JF and superior PPhS without exposition of parapharyngeal segment of internal carotid artery. The ipsilateral nostril approach with ET removal allows to obtain a wider exposure, reaching medial sigmoid part of JF. No significant differences exist in regards to transtubercular and transcondylar approaches. Conclusions: This study suggests that EEA to PPSB allow the realization of a corridor directed to jugular tubercle, occipital condyle, medial parapharyngeal space and ventral-medial JF. The CN approach with ET preservation can expose petrous and intrajugular parts of JF and PPhS. Case series are needed to demonstrate benefits and drawbacks of these approaches.