Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle

View More View Less
  • 1 Division of Neurosurgery, University of São Paulo Medical School;
  • 2 Discipline of Neurosurgery, Santa Casa de São Paulo Medical School, São Paulo, Brazil;
  • 3 Department of Neurological Surgery, University of Florida, Gainesville, Florida; and
  • 4 Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Access to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle. However, the fornix column limits the exposure of the anterior region of the third ventricle. There is evidence that the unilateral section of the fornix column has little effect on cognitive function. This study compared the anatomical exposure afforded by the transforniceal-transchoroidal approach with that of the transchoroidal approach. In addition, a morphometric evaluation of structures that are relevant to and common in the 2 approaches was performed.

METHODS

The anatomical exposure provided by the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches was compared in 8 fresh cadavers, using a neuronavigation system. The working area, microsurgical exposure area, and angular exposure on the longitudinal and transversal planes of 2 anatomical targets (tuber cinereum and cerebral aqueduct) were compared. Additionally, the thickness of the right frontal lobe parenchyma, thickness of the corpus callosum trunk, and longitudinal diameter of the interventricular foramen were measured. The values obtained were submitted to statistical analysis using the Wilcoxon test.

RESULTS

In the quantitative evaluation, compared with the transchoroidal approach, the transforniceal-transchoroidal approach provided a greater mean working area (transforniceal-transchoroidal 150 ± 11 mm2; transchoroidal 121 ± 8 mm2; p < 0.05), larger mean microsurgical exposure area (transforniceal-transchoroidal 101 ± 9 mm2; transchoroidal 80 ± 5 mm2; p < 0.05), larger mean angular exposure area on the longitudinal plane for the tuber cinereum (transforniceal-transchoroidal 71° ± 7°; transchoroidal 64° ± 6°; p < 0.05), and larger mean angular exposure area on the longitudinal plane for the cerebral aqueduct (transforniceal-transchoroidal 62° ± 6°; transchoroidal 55° ± 5°; p < 0.05). No differences were observed in angular exposure along the transverse axis for either anatomical target (tuber cinereum and cerebral aqueduct; p > 0.05). The mean thickness of the right frontal lobe parenchyma was 35 ± 3 mm, the mean thickness of the corpus callosum trunk was 10 ± 1 mm, and the mean longitudinal diameter of the interventricular foramen was 4.6 ± 0.4 mm. In the qualitative assessment, it was noted that the transforniceal-transchoroidal approach led to greater exposure of the third ventricle anterior region structures. There was no difference between approaches in the exposure of the structures of the middle and posterior region.

CONCLUSIONS

The transforniceal-transchoroidal approach provides greater surgical exposure of the third ventricle anterior region than that offered by the transchoroidal approach. In the population studied, morphometric analysis established mean values for anatomical structures common to both approaches.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

INCLUDE WHEN CITING Published online November 4, 2016; DOI: 10.3171/2016.8.JNS16403.

Correspondence João Luiz Vitorino Araujo, Cesário Mota Júnior Street, 112 Vila Buarque, São Paulo 01221-020, Brazil. email: vitorinomed@yahoo.com.br.
  • 1

    Aggleton JP, McMackin D, Carpenter K, Hornak J, Kapur N, Halpin S, : Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix. Brain 123:800815, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bellotti C, Pappadà G, Sani R, Oliveri G, Stangalino C: The transcallosal approach for lesions affecting the lateral and third ventricles. Surgical considerations and results in a series of 42 cases. Acta Neurochir (Wien) 111:103107, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Bengochea FG, De La Torre O, Esquivel O, Vieta R, Fernandez C: The section of the fornix in the surgical treatment of certain epilepsies; a preliminary report. Trans Am Neurol Assoc 13:79th Meeting 176178, 1954

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Cairns H, Mosberg WH Jr: Colloid cyst of the third ventricle. Surg Gynecol Obstet 92:545570, 1951

  • 5

    Campero A, Ajler P, Emmerich J: Abordajes neuroquirúrgicos al cérebro y la base de crâneo ed 1 Buenos Aires, Journal, 2013

  • 6

    Chang EF, Gabriel RA, Potts MB, Berger MS, Lawton MT: Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes. Clinical article. J Neurosurg 114:814827, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Dandy WE: Benign Tumors in the Third Ventricle of the Brain: Diagnosis and Treatment Springfield, IL, C.C. Thomas, 1933

  • 8

    Desai KI, Nadkarni TD, Muzumdar DP, Goel AH: Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surg Neurol 57:295304, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Ehni G, Ehni B, Considerations in transforaminal entry. Apuzzo MLJ: Surgery of the Third Ventricle ed 2 Baltimore, Williams & Wilkins, 1998. 326353

    • Search Google Scholar
    • Export Citation
  • 10

    Figueiredo EG, Deshmukh P, Nakaji P, Crusius MU, Crawford N, Spetzler RF, : The minipterional craniotomy: technical description and anatomic assessment. Neurosurgery 61:5 Suppl 2 256265, 2007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Spetzler RF: The pterional-transsylvian approach: an analytical study. Neurosurgery 62:6 Suppl 3 13611367, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Figueiredo EG, Zabramski JM, Deshmukh P, Crawford NR, Spetzler RF, Preul MC: Comparative analysis of anterior petrosectomy and transcavernous approaches to retrosellar and upper clival basilar artery aneurysms. Neurosurgery 58:1 Suppl ONS13ONS21, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Fujii K, Lenkey C, Rhoton AL Jr: Microsurgical anatomy of the choroidal arteries: lateral and third ventricles. J Neurosurg 52:165188, 1980

  • 14

    Gaffan D, Gaffan EA: Amnesia in man following transection of the fornix. A review. Brain 114:26112618, 1991

  • 15

    Garcia-Bengochea F, Friedman WA: Persistent memory loss following section of the anterior fornix in humans. A historical review. Surg Neurol 27:361364, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Garretson HD, Commentary A - memory in man: a neurosurgeons perspective. Apuzzo MLJ: Surgery of the Third Ventricle ed 2 Baltimore, Williams & Wilkins, 1998. 209212

    • Search Google Scholar
    • Export Citation
  • 17

    Hernesniemi J, Leivo S: Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcallosal microsurgery. Surg Neurol 45:214, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Kandel E, Kupfermann I, Iversen S, Learning and memory. Kandel E, Schwartz J, Jessell T: Principles of Neural Science ed 4 New York, McGraw-Hill, 2000

    • Search Google Scholar
    • Export Citation
  • 19

    Karakaş P, Koç Z, Koç F, Gülhal Bozkır M: Morphometric MRI evaluation of corpus callosum and ventricles in normal adults. Neurol Res 33:10441049, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Konovalov AN, Gorelyshev SK: Surgical treatment of anterior third ventricle tumours. Acta Neurochir (Wien) 118:3339, 1992

  • 21

    Konovalov N, Technique and strategies of direct surgical management of craniopharyngioma. Apuzzo MLJ: Surgery of the Third Ventricle Baltimore, Williams & Wilkins, 1998. 542553

    • Search Google Scholar
    • Export Citation
  • 22

    Koos WT, Perneczky A, Horaczek A: Problems of surgical technique for the treatment of supratentorial midline tumors in children. Acta Neurochir Suppl 35:3141, 1985

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Lang J: Anatomy of the midline. Acta Neurochir Suppl 35:622, 1985

  • 24

    Lang J: Topographic anatomy of preformed intracranial spaces. Acta Neurochir Suppl 54:110, 1992

  • 25

    Little JR, MacCarty CS: Colloid cysts of the third ventricle. J Neurosurg 40:230235, 1974

  • 26

    Mazarakis NK, Summers F, Murray AD, Waiter GD, Fouyas IP: Partial recovery from amnesia following bilateral surgical fornix transection is correlated with cortical plasticity. Br J Neurosurg 25:658661, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    McMackin D, Cockburn J, Anslow P, Gaffan D: Correlation of fornix damage with memory impairment in six cases of colloid cyst removal. Acta Neurochir (Wien) 135:1218, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Morita A, Kelly PJ: Resection of intraventricular tumors via a computer-assisted volumetric stereotactic approach. Neurosurgery 32:920927, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Nagasawa S, Miyake H, Ohta T: [Transcallosal and transcortical approaches for tumors at the anterior part of the lateral ventricle: relations between visualized and ventricular size.]. No Shinkei Geka 25:321327, 1997. (Jpn)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Patel P, Cohen-Gadol AA, Boop F, Klimo P Jr: Technical strategies for the transcallosal transforaminal approach to third ventricle tumors: expanding the operative corridor. J Neurosurg Pediatr 14:365371, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Peltier J, Verclytte S, Delmaire C, Deramond H, Pruvo JP, Le Gars D, : Microsurgical anatomy of the ventral callosal radiations: new destination, correlations with diffusion tensor imaging fiber-tracking, and clinical relevance. J Neurosurg 112:512519, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Rhoton AL Jr: The cerebrum. Anatomy. Neurosurgery 61:1 Suppl 37119, 2007

  • 33

    Sekhar LN, Fessler RG: Atlas of Neurosurgical Techniques: Brain New York, Thieme, 2006

  • 34

    Shucart W, Anterior transcallosal and transcortical approaches. Apuzzo MLJ: Surgery of the Third Ventricle ed 2 Baltimore, Williams & Wilkins, 1998. 303325

    • Search Google Scholar
    • Export Citation
  • 35

    Tomasello F, Cardali S, Angileri FF, Conti A: Transcallosal approach to third ventricle tumors: how I do it. Acta Neurochir (Wien) 155:10311034, 2013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Tsivilis D, Vann SD, Denby C, Roberts N, Mayes AR, Montaldi D, : A disproportionate role for the fornix and mammillary bodies in recall versus recognition memory. Nat Neurosci 11:834842, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Tubbs RS, Oakes P, Maran IS, Salib C, Loukas M: The foramen of Monro: a review of its anatomy, history, pathology, and surgery. Childs Nerv Syst 30:16451649, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Ulm AJ, Russo A, Albanese E, Tanriover N, Martins C, Mericle RM, : Limitations of the transcallosal transchoroidal approach to the third ventricle. J Neurosurg 111:600609, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Wen H: Demonstração anatômica da abordagem transcorioidea à porção anterior do terceiro ventrículo [thesis] São Paulo, Faculdade de Medicina, Universidade de São Paulo, 2002

    • Search Google Scholar
    • Export Citation
  • 40

    Wen HT, Rhoton AL Jr, de Oliveira E: Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application. Neurosurgery 42:12051219, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Winkler PA, Weis S, Büttner A, Raabe A, Amiridze N, Reulen HJ: The transcallosal interforniceal approach to the third ventricle: anatomic and microsurgical aspects. Neurosurgery 40:973982, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Woiciechowsky C, Vogel S, Lehmann R, Staudt J: Transcallosal removal of lesions affecting the third ventricle: an anatomic and clinical study. Neurosurgery 36:117123, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Woolsey RM, Nelson JS: Asymptomatic destruction of the fornix in man. Arch Neurol 32:566568, 1975

  • 44

    Yaşargil MG: Microneurosurgery Stuttgart, Thieme, 1996

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 125 125 7
PDF Downloads 18 18 0
EPUB Downloads 0 0 0