Endoscopic surgical anatomy of the paediatric third ventricle studied using virtual neuroendoscopy based on 3-D ultrasonography.
BACKGROUND
Endoscopic treatment for occlusive hydrocephalus requires knowledge of individual ventricular and vascular anatomies of the ventricular system.


METHODS
We studied the feasibility of virtual neuroendoscopy (VNE) based on 3-D ultrasonography (3-D US) for the identification of parenchymal and vascular anatomical landmarks of the third ventricle and its impact on the surgical planning of endoscopic third ventriculostomy (ETV) in paediatric patients. 3-D US was performed through the anterior fontanel in four infants with hydrocephalus.


RESULTS
Virtual neuroendoscopy revealed the size of the foramen of Monro, anatomical landmarks of the floor of the third ventricle crucial for correct fenestration during ETV, but not the premesencephalic cistern. The basilar bifurcation was identified in relation to the floor of the third ventricle by VNE (power-Doppler ultrasonography) and confirmed intraoperatively after ETV.


CONCLUSIONS
3-D US-based VNE reveals detailed anatomical information on the ventricular system including the foramen of Monro and the floor of the third ventricle. Within the premesencephalic cistern vascular anatomy can be visualized, but not non-vascular structures.
Department of Neurosurgery, University Medical Centre, Justus Liebig University, Klinikstrasse 29, 35385, Giessen, Germany. andreas.joedicke@neuro.med.uni-giessen.de
Andreas
A
Jödicke
L Daniel
LD
Berthold
Wolfram
W
Scharbrodt
Ilona
I
Schroth
Irwin
I
Reiss
Bernd A
BA
Neubauer
Dieter-Karsten
DK
Böker
D002535:Cerebral Aqueduct / Q000002:abnormalities* / Q000601:surgery; D002552:Cerebral Ventricles / Q000033:anatomy & histology; D003251:Constriction, Pathologic / Q000151:congenital / Q000473:pathology / Q000601:surgery; D003616:Dandy-Walker Syndrome / Q000150:complications; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D007839:Functional Laterality; D006801:Humans; D006849:Hydrocephalus / Q000145:classification / Q000209:etiology* / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods; D020542:Third Ventricle / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D018608:Ultrasonography, Doppler; D014584:User-Computer Interface