title: Comparative Anatomical Study on Operability in Surgical Approaches to the Anterior Part of the Third Ventricle.
abstract: BACKGROUND
  Surgery of the third ventricle still represents a challenge in modern neurosurgery. To optimize the surgical planning, some aspects, related to ventricular anatomy, have to be taken into consideration. An operability score could represent a preoperative tool to evaluate these variables to choose a tailored surgical approach.
  
  
  METHODS
  We compared the transcallosal transforaminal approach and the combined interhemispheric subcommissural translamina terminalis approach (CISTA) to the anterior part of the third ventricle, applying the operability score.
  
  
  RESULTS
  Compared with the transcallosal transforaminal approach, the CISTA provides a statistically significant improvement in terms of depth of surgical field, surgical angle of attack, and maneuverability arc considering as 4 approach-related critical structures: the optic chiasm (P value: <0.0001, <0.0001, <0.0001, respectively), the anterior commissure (P value: <0.0001, <0.0001, <0.0001 respectively), the tuber cinereum (P value: <0.0001, 0.0224, 0.0173), and the interthalamic adhesion (P value: 0.2917, <0.0001, <0.0001 respectively).
  
  
  CONCLUSIONS
  Tumors originating from the anterosuperior part of the third ventricle can be easily approached through a transcallosal transforaminal route, whereas lesions arising from the anteroinferior portion of the third ventricle might be safely and effectively approached through the CISTA.
authors: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
authors: Alfio
authors: A
authors: Spina
authors: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Filippo
authors: F
authors: Gagliardi
authors: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Michele
authors: M
authors: Bailo
authors: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Nicola
authors: N
authors: Boari
authors: Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, USA.
authors: Anthony J
authors: AJ
authors: Caputy
authors: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Pietro
authors: P
authors: Mortini
mesh_terms: D002102:Cadaver; D002551:Cerebral Ventricle Neoplasms / Q000601:surgery*; D003337:Corpus Callosum / Q000033:anatomy & histology*; D006801:Humans; D007031:Hypothalamus / Q000033:anatomy & histology*; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D009929:Organ Size; D020542:Third Ventricle / Q000033:anatomy & histology / Q000601:surgery*
keywords: Corpus callosum; Lamina terminalis; Operability score; Optic chiasm; Third ventricle