Article
Endoscopic transaqueductal approach to the third ventricle through the foramen of Magendie – a cadaver study
Der endoskopische transaquäduktale Zugang zum dritten Ventrikel durch das Foramem Magandii – eine anatomische Studie
Search Medline for
Authors
-
Sebastian Senger
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
-
Stefan Linsler
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
-
Jana Rediker
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
-
Thomas Tschernig
- Medizinische Fakultät der Universität des Saarlandes, Anatomisches Institut, Homburg/Saar, Deutschland
-
Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Published: | May 8, 2019 |
|---|
Outline
Text
Objective: The knowledge about the intraventricular anatomy is an important aspect for neuroendoscopic intraventricular surgery. A precoronary approach through the lateral ventricle and the Foramen of Monro is the established standard access to the third ventricle. A more frontal orientated approach or the use of flexible endoscopes might be necessary to access the posterior part of the third ventricle. A hypothetical alternative route might be the transaqueductal approach through the fourth ventricle.
Methods: We performed a feasibility study in eight formalin fixed human cadavers. Two flexible endoscopes with an outer diameter of 2.5 and 3.7 mm were used for the endoscopic procedures. Anatomical structures of the ventricular system were defined. A suboccipital craniotomy was performed. The fourth ventricle was entered through the Foramen of Magendie. The third ventricle was then entered through the aqueduct. The anatomic structures of the third ventricle and the lateral ventricles were identified. Additional attempts to perforate the floor of the third ventricle or the lamina terminalis were performed. A detailed video analysis followed using a questionnaire.
Results: The transaqueductal approach to the third ventricle was achieved in seven of eight cadavers. The main structures of the third ventricle were identified in these seven cases. The lateral ventricles were also entered and inspected. The fenestration of the lamina terminalis was achieved in five of seven cases. There were no signs of unintended tissue damage at the end of the procedure.
Conclusion: The described approach could be a theoretical alternative to access pathologies in the third ventricle and aqueduct. Biopsies and perforation could be performed, too. However the potential risk of perioperative lesions at the aqueduct and the surrounding eloquent structures must be considered. Further improvements of the flexible endoscopes, including smaller diameter and advanced optics, might overcome this problem in the future.
