Extended Endoscopic Endonasal Approach to the Third Ventricle: Multimodal Anatomical Study with Surgical Implications

Cavallo, Luigi Maria; Somma, Alberto Di; Notaris, Matteo de; Prats-Galino, Alberto; Aydın, Salih; Catapano, Giuseppe; Solari, Domenico; Somma, Teresa; Cappabianca, Paolo

doi:10.1016/j.wneu.2015.03.007

Cited by 33 publications

(11 citation statements)

References 48 publications

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“…[ 12 ] Other studies described the anatomy of third ventricle using MI as a landmark. [ 4 18 ] Characteristics of the MI and its variations should be defined preoperatively if possible in selecting the optimal approach.…”

Section: Discussionmentioning

confidence: 99%

The double massa intermedia

et al. 2016

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Background:To describe the rare finding of a double massa intermedia (MI). Typically, the MI (interthalamic adhesion) is a single bridge of gray matter connecting the medial surfaces of the thalami.Methods:Twelve formalin- and alcohol-fixed human third ventricles were examined from superior to inferior by fiber dissection technique under ×6 to ×40 magnifications and with the endoscope.Results:In all hemispheres, the anterior and posterior commissure were defined. The MI, which bridges the medial surfaces of the thalami, was defined in all hemispheres. In one hemisphere, there was a second bridge between the thalami, located posteroinferior to the common MI. Endoscopic view confirmed that there was a second MI in this specimen. The MI usually traverses the third ventricle posterior to the foramen of Monro and connects the paired thalami. The MI is an important landmark during endoscopic and microscopic surgeries of the third ventricle. Although a double MI is very rare, surgeons should be aware of the possibility in their surgical planning.Conclusion:The surgeon should be aware of the possibility of a double MI to avoid confusion during third ventricle surgery.

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Section: Discussionmentioning

confidence: 99%

The double massa intermedia

et al. 2016

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“…From this perspective, there are plenty of data deriving from both cadaveric and intraoperative studies. 1,[5][6][7] Conversely, the anterior, intraventricular face of the posterior wall of the third ventricle has been described mostly in postmortem specimens. 5,8,9 Neurosurgeons who have approached this area in vivo using an endoscope have done so only to explore or biopsy or remove tumors involving the pineal region.…”

Section: Discussionmentioning

confidence: 99%

“…1,[5][6][7] Conversely, the anterior, intraventricular face of the posterior wall of the third ventricle has been described mostly in postmortem specimens. 5,8,9 Neurosurgeons who have approached this area in vivo using an endoscope have done so only to explore or biopsy or remove tumors involving the pineal region. Therefore, only pathological endoscopic anatomy is available for this area.…”

Section: Discussionmentioning

confidence: 99%

A light on the dark side: in vivo endoscopic anatomy of the posterior third ventricle and its variations in hydrocephalus

Feletti

Fiorindi

Lavecchia

et al. 2020

Journal of Neurosurgery

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OBJECTIVEDespite the technological advancements of neurosurgery, the posterior part of the third ventricle has always been the “dark side” of the ventricle. However, flexible endoscopy offers the opportunity for a direct, in vivo inspection and detailed description of the posterior third ventricle in physiological and pathological conditions. The purposes of this study were to describe the posterior wall of the third ventricle, detailing its normal anatomy and surgical landmarks, and to assess the effect of chronic hydrocephalus on the anatomy of this hidden region.METHODSThe authors reviewed the video recordings of 59 in vivo endoscopic explorations of the posterior third ventricle to describe every identifiable anatomical landmark. Patients were divided into 2 groups based on the absence or presence of a chronic dilation of the third ventricle. The first group provided the basis for the description of normal anatomy.RESULTSThe following anatomical structures were identified in all cases: adytum of the cerebral aqueduct, posterior commissure, pineal recess, habenular commissure, and suprapineal recess. Comparing the 2 groups of patients, the authors were able to detect significant variations in the shape of the adytum of the cerebral aqueduct and in the thickness of the habenular and posterior commissures. Exploration with sodium fluorescein excluded the presence of any fluorescent area in the posterior third ventricle, other than the subependymal vascular network.CONCLUSIONSThe use of a flexible scope allows the complete inspection of the posterior third ventricle. The anatomical variations caused by chronic hydrocephalus might be clinically relevant, in light of the commissure functions.

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“…The image produced by an MRI is of much lower resolution than a micro-CT scan image, revealing very little detail. Similar detail to micro-CT scans, can be achieved by producing endoscopic images, which have the added advantage of being in true color (Longatti et al, 2005;Cavallo et al, 2015). Ventriculography prior to surgery is an extremely invasive and expensive procedure that is not readily available or suitable for use in an educational setting, nor does it represent the ventricles in their entirety (Zhao et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Visualization Within the Ventricles of the Brain: A Micro‐Focus X‐Ray Study

Jager

Plessis

Hoffman

et al. 2017

The Anatomical Record

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Conceptualization of the ventricular system of the brain by macroscopic studies is complicated by the lack of physical structure of these interconnected cavities. Dissection procedures designed to display the structures in the walls of the ventricles are destructive and not conducive for the appreciation of the ventricular system in its entirety. The application of Micro-focus X-ray tomography affords the possibility to appreciate hidden structures in a nondestructive manner. The aim of this study was to explore the possibility of using micro-focus X-ray tomography in the three-dimensional (3D) visualization of the ventricular system as well as the various neuroanatomical structures within its walls for educational purposes. Randomly selected embalmed human cadaver brains were scanned at Necsa (South African Nuclear Energy Corporation) housing the MIXRAD laboratory consisting of a Nikon XTH 225 ST micro-focus X-ray tomography facility. A 3D flythrough video of the ventricular system was reconstructed from these scans using software to view the inner surface of the ventricles. Micro-focus X-ray tomography provides feasible means of delivering high-resolution images in a nondestructive way to design a representation of the ventricular system. In addition, structures in the walls of the ventricular system could be appreciated in a novel way. It is envisaged that this 3D-fly-through video of the ventricular system will be valuable when integrated with standard prosections and atlas pictures in the educational setting. Further studies evaluating the use of this integrative visualization of the ventricular system of the brain for its applicability in the educational setting should be performed. Anat Rec, 00:000-000, 2017. © 2017 Wiley Periodicals, Inc.

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Extended Endoscopic Endonasal Approach to the Third Ventricle: Multimodal Anatomical Study with Surgical Implications

Cited by 33 publications

References 48 publications

The double massa intermedia

The double massa intermedia

A light on the dark side: in vivo endoscopic anatomy of the posterior third ventricle and its variations in hydrocephalus

Visualization Within the Ventricles of the Brain: A Micro‐Focus X‐Ray Study

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