Abstract
Basilar artery injury has been known as a potential lethal complication of endoscopic
third ventriculostomy. In order to avoid this complication, endoscopic reverse third
ventriculostomy via a trans-cisterna-magna route was studied. A cadaveric study was
performed for navigation of a flexible endoscope through the cisterna magna. Three
fresh, unfixed cadavers were used for this endoscopic navigation. In the prone position,
a small vertical paramedian skin incision is made at the mid-portion of the posterior
neck. An 11-mm threaded plastic tube is inserted towards the posterior arch of the
atlas. After a partial hemilaminectomy of the atlas, a flexible endoscope is introduced
into the cisterna magna and is navigated cephalad along the vertebrobasilar artery
to the inferior aspect of the floor of the third ventricle. Through the working channel
of a fiberscope, third ventriculostomy is performed in a reverse direction. Additional
detailed anatomy was studied in fixed cadaveric head specimens with a rigid rod-lens
endoscope for anatomic orientation. A novel technique of a trans-cisterna-magna reverse
third ventriculostomy was studied in cadaveric specimens. This technique may avoid
basilar artery injury which occurs occasionally during conventional third ventriculostomy.
Key words
Basilar Artery - Cisterna Magna - Endoscopy - Hydrocephalus - Neuroendoscopy - Third
Ventriculostomy
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H.-D. Jho,M.D., Ph. D.
Professor of Neurological Surgery · Director, Jho Institute for Minimally Invasive
Neurosurgery · Department of Neurological Surgery
Allegheny General Hospital · Suite 312 · East Wing · 420 East North Avenue
Pittsburgh, Pennsylvania 15212-4746, USA
Telefon: +1-412-359-6110
Fax: +1-412-359-4811
eMail: hdjho@drjho.com