Chronic obstructive hydrocephalus commonly presents as daily headaches which are refractory to migraine medications [1-3]. Treatment strategies rely on improvement in CSF hydrodynamics.  Medically, this is obtained with carbonic anhydrase inhibitors.  Surgically, endoscopic third ventriculostomy (ETV) is considered the treatment of choice [4-7].

This is a retrospective review of outcomes in patients who underwent ETV for refractory, daily headaches.  Neurology collaborated with Neurosurgery in headache identification and initiation of complex medical management.  Surgical candidates had headache characteristics consistent with increased intracranial pressure, which improved after treatment with a carbonic anhydrase inhibitor.  These patients underwent MRI with fine-cut sagittal FIESTA protocol. Patients with aqueductal stenosis and presence of a pineal cyst were considered as candidates for ETV.  

Interdisciplinary collaboration for patients with aqueductal stenosis with pineal cyst resulted in improved outcomes for headache management. ETV has demonstrated significant benefit in improving chronic daily headaches in patients responsive to a carbonic anhydrase inhibitor.