Anatomic variations of the floor of the third ventricle: Surgical implications for endoscopic third ventriculostomy

Abdala-Vargas, Nadin J.; Cifuentes-Lobelo, Hernando A.; Ordóñez-Rubiano, Edgar G.; Patiño-Gómez, Javier G.; Villalonga, Juan F.; Lucifero, Alice Giotta; Campero, Álvaro; Forlizzi, Valeria; Baldoncini, Matías; Luzzi, Sabino

doi:10.25259/sni_404_2022

Cited by 5 publications

(1 citation statement)

References 21 publications

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“…Determining the best operative technique and the individualization of the intervention, a CT and MRI are indispensable for evaluating the ventricular size. Finally, it is essential to remember that the presence of anatomic variations must be identified as they influence the success rate of ETV [ 31 ] as they can result in the loss of the anatomic landmarks and lead to a more technically demanding surgical procedure. The incidence of variations was reported to be 36% in a study of 25 patients, and the success rate dropped 44% in ETV of patients presenting anatomic variations [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic anatomy of the third ventricle

da Silva,

Silva,

Alves

et al. 2024

Surg Radiol Anat

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Purpose Endoscopic third ventriculostomy (ETV) is a surgical procedure that can lead to complications and requires detailed preoperative planning. This study aimed to provide a more accurate understanding of the anatomy of the third ventricle and the location of important structures to improve the safety and success of ETV. Methods We measured the stereotactic coordinates of six points of interest relative to a predefined stereotactic reference point in 23 cadaver brain hemi-sections, 200 normal brain magnetic resonance imaging (MRI) scans, and 24 hydrocephalic brain MRI scans. The measurements were statistically analyzed, and comparisons were made. Results We found some statistically significant differences between genders in MRIs from healthy subjects. We also found statistically significant differences between MRIs from healthy subjects and both cadaver brains and MRIs with hydrocephalus, though their magnitude is very small and not clinically relevant. Some stereotactic points were more posteriorly and inferiorly located in cadaver brains, particularly the infundibular recess and the basilar artery. It was found that all stereotactic points studied were more posteriorly located in brains with hydrocephalus. Conclusion The study describes periventricular structures in cadaver brains and MRI scans from healthy and hydrocephalic subjects, which can guide neurosurgeons in planning surgical approaches to the third ventricle. Overall, the study contributes to understanding ETV and provides insights for improving its safety and efficacy. The findings also support that practicing on cadaveric brains can still provide valuable information and is valid for study and training of neurosurgeons unfamiliar with the ETV technique.

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Section: Discussionmentioning

confidence: 99%

Stereotactic anatomy of the third ventricle

da Silva,

Silva,

Alves

et al. 2024

Surg Radiol Anat

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Minimally invasive third ventriculostomy with stereotactic internal shunt placement for the treatment of tumor-associated noncommunicating hydrocephalus

Niedermeyer,

Terpolilli,

Nerlinger

et al. 2023

Acta Neurochir

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Background Intracranial tumors can cause obstructive hydrocephalus (OH). Most often, symptomatic treatment is pursued through ventriculoperitoneal shunt (VS) or endoscopic third ventriculostomy (ETV). In this study, we propose stereotactic third ventriculostomy with internal shunt placement (sTVIP) as an alternative treatment option and assess its safety and efficacy. Methods In this single-center, retrospective analysis, clinical symptoms, procedure-related complications, and revision-free survival of all patients with OH due to tumor formations treated by sTVIP between January 2010 and December 2021 were evaluated. Results Clinical records of thirty-eight patients (11 female, 27 male) with a mean age of 40 years (range 5–88) were analyzed. OH was predominantly (in 92% of patients) caused by primary brain tumors (with exception of 3 cases with metastases). Following sTVIP, 74.2% of patients experienced symptomatic improvement. Preoperative headache was a significant predictor of postoperative symptomatic improvement (OR 26.25; 95% CI 4.1–521.1; p = 0.0036). Asymptomatic hemorrhage was detected along the stereotactic trajectory in 2 cases (5.3%). One patient required local revision due to CSF fistula (2.6%); another patient had to undergo secondary surgery to connect the catheter to a valve/abdominal catheter due to CSF malabsorption. However, in the remaining 37 patients, shunt independence was maintained during a median follow-up period of 12 months (IQR 3–32 months). No surgery-related mortality was observed. Conclusions sTVIP led to a significant symptom control and was associated with low operative morbidity, along with a high rate of ventriculoperitoneal shunt independency during the follow-up period. Therefore, sTVIP constitutes a highly effective and minimally invasive treatment option for tumor-associated obstructive hydrocephalus, even in cases with a narrow prepontine interval.

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