Endoscope-assisted infratentorial-supracerebellar approach to the third ventricle: an anatomical study.
OBJECTIVE
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.
Cardia
Andrea
A
Department of Neurosurgery, Galeazzi Hospital, Milan, Italy.
Caroli
Manuela
M
Pluderi
Mauro
M
Arienta
Cesare
C
Gaini
Sergio M
SM
Lanzino
Giuseppe
G
Tschabitscher
Manfred
M
D000328:Adult; D002102:Cadaver; D002531:Cerebellum / Q000033:anatomy & histology; D002550:Cerebral Veins / Q000033:anatomy & histology; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D044583:Neuroendoscopy; D010870:Pineal Gland / Q000033:anatomy & histology*; D013687:Telencephalon / Q000033:anatomy & histology*; D020542:Third Ventricle / Q000033:anatomy & histology* / Q000601:surgery*