Endoscope-assisted infratentorial–supracerebellar approach to the third ventricle: an anatomical study

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  • 1 Department of Neurosurgery, Galeazzi Hospital, Milan; Division of Neurosurgery, Department of Neurological Sciences, University of Milan; Ospedale Maggiore Policlinico Mangiagallie Regina Elena di Milano, IRCCS; Neurosurgery, Department of Surgery, University of Pavia, Policlinico San Matteo, Pavia, IRCCS, Italy; Department of Neurosurgery and Neurosurgical Lab, University of Illinois, Peoria, Illinois; and Microsurgical and Endoscopic Lab, I Anatomic Institute, University of Vienna, Austria
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Object

The authors studied the microsurgical anatomy and endoscopic features of the pineal region and third ventricle to describe a combined microsurgical–endoscopic infratentorial–supracerebellar approach to the posterior third ventricle. Such an approach exposes the pineal gland and its complex neurovascular structures so that the third ventricle can be reached through a minimally invasive parapineal incision.

Methods

The approach was studied in 10 adult cadaveric heads, six fresh and four formalin fixed, by using an operative microscope with a magnification level of 6 to 40 and the assistance of an endoscope.

The endoscope-assisted infratentorial–supracerebellar approach affords a complete view of the third ventricle from a posterior perspective. The third ventricle is entered through a parapineal incision using the natural space between the internal cerebral vein and the vein of Rosenthal located above the superior colliculi.

Conclusions

The infratentorial–supracerebellar approach to the third ventricle follows a natural corridor and requires minimal retraction and resection of critical neural structures. With the use of the endoscope, an unsurpassed view into the third ventricle from a posterior perspective is obtained.

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

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