Interhemispheric Endoscopic Fenestration of the Lamina Terminalis through a Single Frontal Burr Hole

Abstract

Objective We evaluate the feasibility and safety of performing a novel interhemispheric endoscopic fenestration of the lamina terminalis (IEFLT) through a single frontal burr hole immediately lateral to the superior sagittal sinus.

Methods Five cadaveric heads underwent IEFLT. Sequential burr holes were made beginning above the glabella and progressed cranially to caudally until the frontal sinus. An endoscope was inserted, and interhemispheric dissection of the arachnoid membranes was completed with endoscopic instruments in a straight direction from the point of entry to the lamina terminalis (LT). Angled optics (0 and 30 degrees) were used to study the neurovascular structures and surgical landmarks.

Results The IEFLTs were successfully completed in all specimens and allowed for good visualization of the inferior portion of the LT. The arachnoid dissections were achieved uneventfully. The endoscope provided good surface control of the LT and excellent stereoscopic visualization of the neurovascular complexes. Improved circumferential visualization of the superior part of the anterior portion of the third ventricle was attained.

Conclusion IEFLT is a potential alternative to the classic endoscopic third ventriculostomy and a simpler alternative to the subfrontal EFLT, although surgical maneuverability is still limited due to the size of the probe in relation to the narrow surgical corridor.

Keywords

lamina terminalis - endoscopic - fenestration - burr hole - third ventriculostomy

• References

• 1 Gaab MR, Schroeder HWS, Oertel JMK. Neuroendoscopic approach to intraventricular tumors. In: Schmidek HH, Roberts DW, , eds. Schmidek & Sweet Operative Neurosurgical Techniques. Indications, Methods, Results. 5th ed. Philadelphia, PA: WB Saunders; 2006: 739-752
• 2 Oertel J, Schroeder HWS, Gaab MR. Third ventriculostomy for treatment of hydrocephalus: results of 271 procedures. Neurosurg Q 2006; 16: 24-31
• 3 Etus V, Ceylan S. The role of endoscopic third ventriculostomy in the treatment of triventricular hydrocephalus seen in children with achondroplasia. J Neurosurg 2005; 103 (3, Suppl): 260-265
• 4 Abdou MS, Cohen AR. Endoscopic surgery of the third ventricle: the subfrontal trans-lamina terminalis approach. Minim Invasive Neurosurg 2000; 43 (4) 208-211
• 5 Spena G, Fasel J, Tribolet Nd, Radovanovic I. Subfrontal endoscopic fenestration of lamina terminalis: an anatomical study. Minim Invasive Neurosurg 2008; 51 (6) 319-323
• 6 Daniel RT, Lee GY, Reilly PL. Suprapineal recess: an alternate site for third ventriculostomy? Case report. J Neurosurg 2004; 101 (3) 518-520
• 7 van Lindert EJ. Microsurgical third ventriculocisternostomy as an alternative to ETV: report of two cases. Childs Nerv Syst 2008; 24 (6) 757-761
• 8 Rangel-Castilla L, Hwang SW, Jea A, Torres-Corzo J. Efficacy and safety of endoscopic transventricular lamina terminalis fenestration for hydrocephalus. Neurosurgery 2012; 71 (2) 464-473 ; discussion 473
• 9 Oertel JM, Vulcu S, Schroeder HW, Konerding MA, Wagner W, Gaab MR. Endoscopic transventricular third ventriculostomy through the lamina terminalis. J Neurosurg 2010; 113 (6) 1261-1269
• 10 Schroeder HW, Oertel J, Gaab MR. Endoscopic treatment of cerebrospinal fluid pathway obstructions. Neurosurgery 2007; 60 (2) (Suppl. 01) ONS44-ONS51 ; discussion ONS51–ONS52
• 11 Borgbjerg BM, Gjerris F, Albeck MJ, Hauerberg J, Børgesen SV. A comparison between ventriculo-peritoneal and ventriculo-atrial cerebrospinal fluid shunts in relation to rate of revision and durability. Acta Neurochir (Wien) 1998; 140 (5) 459-464 ; discussion 465
• 12 Lam CH, Villemure JG. Comparison between ventriculoatrial and ventriculoperitoneal shunting in the adult population. Br J Neurosurg 1997; 11 (1) 43-48
• 13 Udvarhelyi GB, Wood JH, James Jr AE, Bartelt D. Results and complications in 55 shunted patients with normal pressure hydrocephalus. Surg Neurol 1975; 3 (5) 271-275
• 14 Krishna V, Blaker B, Kosnik L, Patel S, Vandergrift W. Trans-lamina terminalis approach to third ventricle using supraorbital craniotomy: technique description and literature review for outcome comparison with anterior, lateral and trans-sphenoidal corridors. Minim Invasive Neurosurg 2011; 54 (5–6) 236-242
• 15 Akyuz M, Tuncer R. The effects of fenestration of the interpeduncular cistern membrane arousted to the opening of lamina terminalis in patients with ruptured ACoA aneurysms: a prospective, comparative study. Acta Neurochir (Wien) 2006; 148 (7) 725-731 ; discussion 731–732
• 16 Andaluz N, Zuccarello M. Fenestration of the lamina terminalis as a valuable adjunct in aneurysm surgery. Neurosurgery 2004; 55 (5) 1050-1059
• 17 Komotar RJ, Olivi A, Rigamonti D, Tamargo RJ. Microsurgical fenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2002; 51 (6) 1403-1412 ; discussion 1412–1413
• 18 Lehto H, Dashti R, Karataş A, Niemelä M, Hernesniemi JA. Third ventriculostomy through the fenestrated lamina terminalis during microneurosurgical clipping of intracranial aneurysms: an alternative to conventional ventriculostomy. Neurosurgery 2009; 64 (3) 430-434 ; discussion 434–435
• 19 Sindou M. Favourable influence of opening the lamina terminalis and Lilliequist's membrane on the outcome of ruptured intracranial aneurysms. A study of 197 consecutive cases. Acta Neurochir (Wien) 1994; 127 (1–2) 15-16
• 20 Tomasello F, d'Avella D, de Divitiis O. Does lamina terminalis fenestration reduce the incidence of chronic hydrocephalus after subarachnoid hemorrhage?. Neurosurgery 1999; 45 (4) 827-831 ; discussion 831–832
• 21 Mura J, Figueiredo EG, Carmona P, Palma-Fellemberg Á, de Faria JW. The anterior ventriculo-cisternostomy: the pioneers' work revisited. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (3) 146-151