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J Neurol Surg B Skull Base 2023; 84(03): 296-306
DOI: 10.1055/a-1808-1359
Original Article

Endoscopic Endonasal Approach to the Third Ventricle Using the Surgical Corridor of the Reverse Third Ventriculostomy: Anatomo-Surgical Nuances

Ali Karadag
1   Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey
2   Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
,
Mahmut Camlar
1   Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey
,
Omer Furkan Turkis
2   Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
3   Department of Neurosurgery, Health Science University, Van Research and Training Hospital, Van, Turkey
,
Nijat Bayramli
1   Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey
2   Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
,
Erik H. Middlebrooks
4   Departments of Neurosurgery and Radiology, Mayo Clinic, Jacksonville, Florida, United States
,
Necmettin Tanriover
2   Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
5   Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University–Cerrahpasa, Istanbul, Turkey
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Abstract

Objective Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures.

Methods Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle.

Results The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella, and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly.

Conclusion The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and precommissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.

Keywords

craniopharyngioma - endoscopy - skull base surgery - tuber cinereum - third ventricle - reverse third ventriculostomy


Publication History

Received: 10 October 2021

Accepted: 18 March 2022

Accepted Manuscript online:
24 March 2022

Article published online:
06 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Yamamoto I, Rhoton Jr AL, Peace DA. Microsurgery of the third ventricle: part I. Microsurgical anatomy. Neurosurgery 1981; 8 (03) 334-356
    CrossrefPubMedGoogle Scholar
  • 2 Apuzzo M. Radiology of Third Ventricular Lesions. In: Thomas CC. ed. Surgery of the third ventricle.. Baltimore: Williams & Wilkins; 1987: 268-272
    Google Scholar
  • 3 Rhoton Jr AL, Yamamoto I, Peace DA. Microsurgery of the third ventricle: part 2. Operative approaches. Neurosurgery 1981; 8 (03) 357-373
    CrossrefPubMedGoogle Scholar
  • 4 Silveira-Bertazzo G, Manjila S, Carrau RL, Prevedello DM. Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions. Acta Neurochir (Wien) 2020; 162 (10) 2403-2408
    CrossrefPubMedGoogle Scholar
  • 5 Ludwig E, Klingler J. Atlas Cerebri Humani. Basel: S. Karger; 1956
    Google Scholar
  • 6 Horn A, Li N, Dembek TA. et al. Lead-DBS v2: towards a comprehensive pipeline for deep brain stimulation imaging. Neuroimage 2019; 184: 293-316
    CrossrefPubMedGoogle Scholar
  • 7 Neudorfer C, Germann J, Elias GJB, Gramer R, Boutet A, Lozano AM. A high-resolution in vivo magnetic resonance imaging atlas of the human hypothalamic region. Sci Data 2020; 7 (01) 305
    CrossrefPubMedGoogle Scholar
  • 8 Cartmell SC, Tian Q, Thio BJ. et al. Multimodal characterization of the human nucleus accumbens. Neuroimage 2019; 198: 137-149
    CrossrefPubMedGoogle Scholar
  • 9 Brown CA, Johnson NF, Anderson-Mooney AJ. et al. Development, validation and application of a new fornix template for studies of aging and preclinical Alzheimer's disease. Neuroimage Clin 2016; 13: 106-115
    CrossrefPubMedGoogle Scholar
  • 10 Edlow BL, Mareyam A, Horn A. et al. 7 Tesla MRI of the ex vivo human brain at 100 micron resolution. Sci Data 2019; 6 (01) 244
    CrossrefPubMedGoogle Scholar
  • 11 Kim MH, Jho HD. Endoscopic reverse third ventriculostomy via the cisterna magna: anatomical study and proposal of a novel procedure. Minim Invasive Neurosurg 2002; 45 (02) 84-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Almeida JP, Suppiah S, Karekezi C. et al. Extended endoscopic approach for resection of craniopharyngiomas. J Neurol Surg B Skull Base 2018; 79 (02) S201-S202
    PubMedGoogle Scholar
  • 13 Abbott R. History of neuroendoscopy. Neurosurg Clin N Am 2004; 15 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 14 Grant JA. Victor Darwin Lespinasse: a biographical sketch. Neurosurgery 1996; 39 (06) 1232-1233
    CrossrefPubMedGoogle Scholar
  • 15 Cohen-Gadol AA, Geryk B, Binder DK, Tubbs RS. Conquering the third ventricular chamber. J Neurosurg 2009; 111 (03) 590-599
    CrossrefPubMedGoogle Scholar
  • 16 Dandy WE. enign Tumors in the Third Ventricle of the Brain: Diagnosis and Treatment. In: Thomas CC, ed. Illionis. Springfield; 1933: S171-171
    Google Scholar
  • 17 Abosch AMM, Wilson CB. Lateral ventricular tumors. In: Kaye AH BP, ed. Operative Neurosurgery. New York: Churchill Livingstone; 2000: 799-812
    Google Scholar
  • 18 Gaab MR, Schroeder HW. Neuroendoscopic approach to intraventricular lesions. J Neurosurg 1998; 88 (03) 496-505
    CrossrefPubMedGoogle Scholar
  • 19 Liu JK, Christiano LD, Gupta G, Carmel PW. Surgical nuances for removal of retrochiasmatic craniopharyngiomas via the transbasal subfrontal translamina terminalis approach. Neurosurg Focus 2010; 28 (04) E6
    CrossrefPubMedGoogle Scholar
  • 20 Maira G, Anile C, Colosimo C, Cabezas D. Craniopharyngiomas of the third ventricle: trans-lamina terminalis approach. Neurosurgery 2000; 47 (04) 857-863 , discussion 863–865
    CrossrefPubMedGoogle Scholar
  • 21 Silva PS, Cerejo A, Polónia P, Pereira J, Vaz R. Trans-lamina terminalis approach for third ventricle and suprasellar tumours. Clin Neurol Neurosurg 2013; 115 (09) 1745-1752
    CrossrefPubMedGoogle Scholar
  • 22 Türe U, Yaşargil MG, Al-Mefty O. The transcallosal-transforaminal approach to the third ventricle with regard to the venous variations in this region. J Neurosurg 1997; 87 (05) 706-715
    CrossrefPubMedGoogle Scholar
  • 23 Ulm AJ, Russo A, Albanese E. et al. Limitations of the transcallosal transchoroidal approach to the third ventricle. J Neurosurg 2009; 111 (03) 600-609
    CrossrefPubMedGoogle Scholar
  • 24 Cardia A, Caroli M, Pluderi M. et al. Endoscope-assisted infratentorial-supracerebellar approach to the third ventricle: an anatomical study. J Neurosurg 2006; 104 (6, Suppl): 409-414
    PubMedGoogle Scholar
  • 25 Chibbaro S, Di Rocco F, Makiese O. et al. Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 2012; 35 (03) 331-338 , discussion 338–340
    CrossrefPubMedGoogle Scholar
  • 26 Shiramizu H, Hori T, Matsuo S. et al. Anterior callosal section is useful for the removal of large tumors invading the dorsal part of the anterior third ventricle: operative technique and results. Neurosurg Rev 2013; 36 (03) 467-475
    CrossrefPubMedGoogle Scholar
  • 27 Cavallo LM, Prevedello DM, Solari D. et al. Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. J Neurosurg 2009; 111 (03) 578-589
    CrossrefPubMedGoogle Scholar
  • 28 Cavallo LM, de Divitiis O, Aydin S. et al. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations—part 1. Operative Neurosurgery 2007; 61: ONS-24-ONS-34
    CrossrefPubMedGoogle Scholar
  • 29 Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E. The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery 2006;59 (1, Suppl 1):ONS50–ONS57, discussion ONS50–ONS57
    PubMedGoogle Scholar
  • 30 Gardner PA, Kassam AB, Snyderman CH. et al. Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. J Neurosurg 2008; 109 (01) 6-16
    CrossrefPubMedGoogle Scholar
  • 31 Apuzzo ML, Chikovani OK, Gott PS. et al. Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences. Neurosurgery 1982; 10 (05) 547-554
    CrossrefPubMedGoogle Scholar
  • 32 Aggleton JP, Brown MW. Episodic memory, amnesia, and the hippocampal-anterior thalamic axis. Behav Brain Sci 1999; 22 (03) 425-444 , discussion 444–489
    CrossrefPubMedGoogle Scholar
  • 33 Konovalov AN, Gorelyshev SK. Surgical treatment of anterior third ventricle tumours. Acta Neurochir (Wien) 1992; 118 (1-2): 33-39
    CrossrefPubMedGoogle Scholar
  • 34 Naidich TP, Daniels DL, Pech P, Haughton VM, Williams A, Pojunas K. Anterior commissure: anatomic-MR correlation and use as a landmark in three orthogonal planes. Radiology 1986; 158 (02) 421-429
    CrossrefPubMedGoogle Scholar
  • 35 Peltier B. The Psychology of Executive Coaching: Theory and Application. New York: Taylor & Francis; 2011
    CrossrefGoogle Scholar
  • 36 Botez-Marquard T, Botez MI. Visual memory deficits after damage to the anterior commissure and right fornix. Arch Neurol 1992; 49 (03) 321-324
    CrossrefPubMedGoogle Scholar
  • 37 Allen LS, Gorski RA. Sexual orientation and the size of the anterior commissure in the human brain. Proc Natl Acad Sci U S A 1992; 89 (15) 7199-7202
    CrossrefPubMedGoogle Scholar
  • 38 Vertes RP, Albo Z, Viana Di Prisco G. Theta-rhythmically firing neurons in the anterior thalamus: implications for mnemonic functions of Papez's circuit. Neuroscience 2001; 104 (03) 619-625
    CrossrefPubMedGoogle Scholar
  • 39 Thomas AG, Koumellis P, Dineen RA. The fornix in health and disease: an imaging review. Radiographics 2011; 31 (04) 1107-1121
    CrossrefPubMedGoogle Scholar
  • 40 Copenhaver BR, Rabin LA, Saykin AJ. et al. The fornix and mammillary bodies in older adults with Alzheimer's disease, mild cognitive impairment, and cognitive complaints: a volumetric MRI study. Psychiatry Res 2006; 147 (2-3): 93-103
    CrossrefPubMedGoogle Scholar
  • 41 Cacciola A, Milardi D, Calamuneri A. et al. Constrained spherical deconvolution tractography reveals cerebello-mammillary connections in humans. Cerebellum 2017; 16 (02) 483-495
    CrossrefPubMedGoogle Scholar
  • 42 Bear MH, Reddy V, Bollu PC. Neuroanatomy, Hypothalamus. Treasure Island (FL): StatPearls [Internet]; 2020
    Google Scholar
  • 43 Kwon HG, Lee HD, Jang SH. Injury of the mammillothalamic tract in patients with thalamic hemorrhage. Front Hum Neurosci 2014; 8: 259
    PubMedGoogle Scholar
  • 44 Hori T, Kawamata T, Amano K, Aihara Y, Ono M, Miki N. Anterior interhemispheric approach for 100 tumors in and around the anterior third ventricle. Neurosurgery 2010; 66 (3, Suppl Operative): 65-74
    PubMedGoogle Scholar
  • 45 Pergola G, Güntürkün O, Koch B, Schwarz M, Daum I, Suchan B. Recall deficits in stroke patients with thalamic lesions covary with damage to the parvocellular mediodorsal nucleus of the thalamus. Neuropsychologia 2012; 50 (10) 2477-2491
    CrossrefPubMedGoogle Scholar
  • 46 Metzler-Baddeley C, Jones DK, Belaroussi B, Aggleton JP, O'Sullivan MJ. Frontotemporal connections in episodic memory and aging: a diffusion MRI tractography study. J Neurosci 2011; 31 (37) 13236-13245
    CrossrefPubMedGoogle Scholar
  • 47 Ghika-Schmid F, Bogousslavsky J. The acute behavioral syndrome of anterior thalamic infarction: a prospective study of 12 cases. Ann Neurol 2000; 48 (02) 220-227
    CrossrefPubMedGoogle Scholar
  • 48 Asa SL, Ezzat S. An Update on Pituitary Neuroendocrine Tumors Leading to Acromegaly and Gigantism. J Clin Med. 2021;10(11)
    PubMedGoogle Scholar
  • 49 Carmichael J.D., Braunstein G.D.. Diseases of Hypothalamic Origin. In D. W. Pfaff, A. P. Arnold & R. T. Rubin (Eds.), Hormones, Brain and Behavior 2009; 3005-3048
    PubMedGoogle Scholar
  • 50 Nishioka H, Fukuhara N, Yamaguchi-Okada M, Yamada S. Endoscopic endonasal surgery for purely intrathird ventricle craniopharyngioma. World Neurosurg 2016; 91: 266-271
    CrossrefPubMedGoogle Scholar
  • 51 Fomichev D, Kalinin P, Kutin M, Sharipov O. Extended transsphenoidal endoscopic endonasal surgery of suprasellar craniopharyngiomas. World Neurosurg 2016; 94: 181-187
    CrossrefPubMedGoogle Scholar