Microsurgery of the Third Ventricle: Part 1

Neurosurgery ◽  
1981 ◽  
Vol 8 (3) ◽  
pp. 334-356 ◽  
Author(s):  
Isao Yamamoto ◽  
Albert L. Rhoton ◽  
David A. Peace
Keyword(s):  
Lateral Ventricle ◽  
Anterior Part ◽  
Third Ventricle ◽  
Posterior Part ◽  
Posterior Wall ◽  
Pineal Region ◽  
Circle Of Willis ◽  
Cerebral Vein ◽  
Foramen Of Monro ◽  
3Rd Ventricle

Abstract The 3rd ventricle is one of the most surgically inaccessible areas in the brain. It is impossible to reach its cavity without incising some neural structures. Twenty-five cadaveric brains were examined in detail to evaluate the surgically important relationships of the walls of the 3rd ventricle. The routes through which the 3rd ventricle can be reached are: (a) from above, through the foramen of Monro and the roof after entering the lateral ventricle through the corpus callosum or the cerebral cortex; (b) from anterior, through the lamina terminalis; (c) from below, through the floor if it has been stretched by tumor; and (d) from posterior, through the pineal region or from the posterior part of the lateral ventricle through the crus of the fornix. The posterior part of the circle of Willis and the basilar artery are intimately related to the floor, the anterior part of the circle of Willis and the anterior cerebral and anterior communicating arteries are related to the anterior wall, and the posterior cerebral artery supplies the posterior wall. The deep cerebral venous system is intimately related to the 3rd ventricle; the internal cerebral vein is related to the roof, and the basal vein is related to the floor. The junction of these veins with the great vein forms a formidable obstacle to the operative approach to the pineal gland and the posterior part of the 3rd ventricle.

scholarly journals Intraventricular Tumor: An Analysis of 18 Cases

2016 ◽  
Vol 13 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Shamsul Alam ◽  
Abu NW Uddin ◽  
Mashiur R Majumder ◽  
Md M Hasan ◽  
Anis Ahmed
Keyword(s):  
Anterior Part ◽  
Third Ventricle ◽  
Posterior Part ◽  
Foramen Of Monro ◽  
Intraventricular Tumors ◽  
Piecemeal Resection ◽  
Neurovascular Structures ◽  
Tumor Debulking ◽  
Neurosurgical Techniques ◽  
Transcortical Approach

The main objective of this article is to describe transcallosal and transcortical approach to deal with intraventricular tumors.Details of the transcallosal and transcortical approach to intraventricular tumors of the lateral and third ventricles were presented.Intraventricular tumors are ideal indications for microscopic neurosurgery. They often cause cerebrospinal fluid (CSF) pathway obstruction, resulting in ventricular dilatation. The general principle of removal of intraventricular tumors is interruption of the blood supply to the tumor and subsequent tumor debulking. In general, a piecemeal resection was performed; however, in some tumors such as meningioma, it was possible to detach the lesion from the surrounding brain tissue and remove it in toto. When the tumor arised in the anterior part of the third ventricle, the craniotomy was made at the coronal suture. When the tumor is located in the posterior part, the entry craniotomy was selected more anteriorly in order to pass the foramen of Monro in a straight line.Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with micro neurosurgical techniques, either by transcallosal or transcortical approach. The aim should be the total extraction of the tumor with minimum damage and the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures. Lateral ventricle tumors can be removed via transcortical approach when having hydrocephalus which provides a wider and more direct approach to the tumor than the transcallosal one. It allows the surgeon to achieve good functional outcome and maximum excision of the tumor. Transcallosal is an excellent midline exposure with preserving the callosomerginal and pericallosal arteriesto the midline tumor of lateral and 3rd ventricles.Nepal Journal of Neuroscience 13:23-29, 2016

Microsurgical Anatomy of the Venous Drainage of the Mesencephalodiencephalic Junction

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 678-686 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Third Ventricle ◽  
Posterior Part ◽  
Pineal Region ◽  
Pineal Body ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Jugular Veins ◽  
Topographic Anatomy ◽  
Adjacent Structures

Abstract OBJECTIVE The veins draining the posterior wall of the third ventricle and its adjacent structures and the posterior part of the midbrain have been the most neglected of the intracranial vascular structures in both the anatomic and neurosurgical literature. During our dissections of the pineal region and the quadrigeminal cistern, we did not always encounter topographic anatomy as described in previous articles. The purpose of this study is to describe the topographic anatomy and normal variations of the specific veins that drain the collicular plate and the pineal body and their adjacent structures with a view to better defining neurosurgical approaches to the pineal region. METHODS The deep cerebral veins draining the pineal body, the collicular plate, and their surrounding neural structures were examined on both sides of 25 adult cadaveric brains. In all specimens, the carotid and vertebral arteries and the jugular veins were perfused with red or blue silicone, respectively, to facilitate dissection under ×3 to ×40 magnification. RESULTS The venous plexus on the dorsal aspect of the collicular plate drains via collicular veins according to three different patterns. These types of drainage are closely related to the existence or absence of the basal vein on one or both sides. CONCLUSION The veins draining the superior and inferior aspects of the pineal body form a superior and an inferior pineal vein that usually drain into the internal or great cerebral vein.

scholarly journals Intraventricular Tumor: An Analysis of 18 Cases

2015 ◽  
Vol 31 (2) ◽  
pp. 94-101
Author(s):  
Shamsul Alam ◽  
AN Wakil Uddin ◽  
Mashiur Rahman Majumder ◽  
Md Motasimul Hasan ◽  
Anis Ahmed
Keyword(s):  
Anterior Part ◽  
Third Ventricle ◽  
Posterior Part ◽  
Foramen Of Monro ◽  
Straight Line ◽  
Intraventricular Tumors ◽  
Piecemeal Resection ◽  
Neurovascular Structures ◽  
Tumor Debulking ◽  
Transcortical Approach

Objective: To describe the transcallosal and transcortical approach to deal with intraventricular tumors. Methods: Details of the transcallosal and transcortical approach to intraventricular tumors of the lateral and third ventricles were presented. Results: Intraventricular tumors are ideal indications for microscopic neurosurgery. They often cause cerebrospinal fluid (CSF) pathway obstruction, resulting in ventricular dilatation. The general principle of removal of intraventricular tumors was interruption of the blood supply to the tumor and subsequent tumor debulking. In general, a piecemeal resection was performed; however, in some tumors such as meningioma, it was possible to detach the lesion from the surrounding brain tissue and remove it in toto. When the tumor found in the anterior part of the third ventricle, the craniotomy was done at the coronal suture. When the tumor was located in the posterior part, the entry craniotomy was selected more anteriorly in order to pass the foramen of Monro in a straight line. Conclusion: Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with micro neurosurgical techniques, either by transcallosal or transcortical approach. The aim should be the total extraction of the tumor with minimum damage and the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures. Lateral ventricle tumors can be removed via transcortical approach when having hydrocephalus which provides a wider and more direct approach to the tumor than the transcallosal one. It allows the surgeon to achieve good functional outcome and maximum excision of the tumor. Transcallosal is an excellent midline exposure with preserving the callosomerginal and pericallosal arteriesto the midline tumor of lateral and 3rd ventricles. Bangladesh Journal of Neuroscience 2015; Vol. 31 (2): 94-101

Endoscopic Biopsy of Intraventricular Tumors with the Use of a Ventriculofiberscope

Neurosurgery ◽  
1978 ◽  
Vol 2 (2) ◽  
pp. 110-113 ◽  
Author(s):  
Takanori Fukushima
Keyword(s):  
Lateral Ventricle ◽  
Pineal Region ◽  
Endoscopic Biopsy ◽  
Histological Diagnosis ◽  
Intraventricular Tumor ◽  
Anterior Portion ◽  
3Rd Ventricle ◽  
Intraventricular Tumors ◽  
Made In

Abstract The results of endoscopic biopsy in 21 cases of intraventricular tumor are presented. The details of the equipment are given. Of the 21 tumors biopsied, there were 9 in the lateral ventricle, 2 in the thalamus, 6 in the anterior portion of the 3rd ventricle, and 4 in the pineal region. A correct histological diagnosis was made in 11 cases (52.4%). No serious complications were noted. The value of the procedure is discussed.

Three-Dimensional Simulation of Collision-Free Paths for Combined Endoscopic Third Ventriculostomy and Pineal Region Tumor Biopsy: Implications for the Design Specifications of Future Flexible Endoscopic Instruments

2015 ◽  
Vol 12 (3) ◽  
pp. 231-238 ◽  
Author(s):  
Kyle W Eastwood ◽  
Vivek P Bodani ◽  
James M Drake
Keyword(s):  
Software Package ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Tumor Margin ◽  
Pineal Region Tumor

Abstract BACKGROUND Recent innovations to expand the scope of intraventricular neuroendoscopy have focused on transitioning multiple-incision procedures into single-corridor approaches. However, the successful adoption of these combined procedures requires minimizing the unwanted torques applied to surrounding healthy structures. OBJECTIVE To define the geometry of relevant anatomical structures in endoscopic third ventriculostomy (ETV) and pineal region tumor biopsy (ETB). Second, to determine the optimal instrument shaft path required for collision-free single burr hole combined ETV/ETB. METHODS Magnetic resonance and computed tomography data from 15 pediatric patients who underwent both ETV and ETB procedures between 2006 and 2014 was segmented by using the 3DSlicer software package to create virtual 3-D patient models. Anatomical regions of interest were measured including the foramen of Monro, the massa intermedia, the floor of the third ventricle, and the tumor margin. Utilizing the MATLAB software package, virtual dexterous instruments were inserted into the models and optimal dimensions were calculated. RESULTS The diameters of the foramen of Monro, massa intermedia (anterior-posterior, superior-inferior), anterior third ventricle, and tumor margin are 6.85, 4.01, 5.05, 14.2, and 28.5 mm, respectively. The average optimal burr placement was determined to be 22.5 mm anterior to the coronal and 30 mm lateral to the sagittal sutures. Optimal flexible instrument geometries for novel instruments were calculated. CONCLUSION We have established a platform for estimating the shape of novel curved dexterous instruments for collision-free targeting of multiple intraventricular points, which is both patient and tool specific and can be integrated with image guidance. These data will aid in developing novel dexterous instruments.

scholarly journals Reinvestigation of the origins of pineal meningiomas based on its related veins and arachnoid membranes

2019 ◽  
Author(s):  
Lei Yu ◽  
Berdimyrat Orazmyradov ◽  
Songtao Qi ◽  
Ye Song ◽  
Luxiong Fang
Keyword(s):  
Posterior Part ◽  
Vertical Motion ◽  
Pineal Region ◽  
Video Data ◽  
Pathological Examination ◽  
Subtotal Resection ◽  
Cerebral Vein ◽  
Straight Sinus ◽  
Velum Interpositum ◽  
Medical University

Abstract Background: A series of patients harboring pineal region meningiomas were respectively analyzed to explore the origin of these tumors and the true meaning of the term "velum interpositum (VI) meningiomas".Methods: 21 patients with pineal meningiomas underwent operation in Nanfang Hospital of Southern Medical University from January 2005 to December 2016 were retrospectively included to analyze the clinical features, imaging findings and surgical video data of these patients. According to the method of literature, the data of this group were also divided into falcotentorial (FT) meningiomas and VI meningiomas, and the differences between the two types of tumors were compared.Results: Among the 21 cases of tumor, there were 12 cases of FT meningiomas, including 4 cases originating from cerebral falx, 4 cases from tentorium of cerebellum and 4 cases from straight sinus; there were 9 cases of VI meningiomas, 7 of which originated from the arachnoid sleeve of the Galen vein, 1 from the posterior part of the internal cerebral vein and 1 from the posterior surface of the pineal gland. Postoperative pathological examination showed meningiomas in all the 21 patients, including 16 cases of total resection and 5 cases of subtotal resection. Postoperatively limitation of binocular vertical motion was found in 3 cases, homotropic hemianopia in 7 cases, hemiplegia in 1 case and death in 1 case.Conclusions: This study suggests that pineal meningiomas are more suitable to be described by FT meningioma and primary pineal meningiomas by analyzing the origin of tumors. The term "VI meningiomas" can not accurately reflect the origin of pineal meningiomas. Before the removal of pineal meningiomas, more attention should be paid to the effects of the two types of tumors on the Galen vein and the straight sinus, and the establishment of venous collateral circulation.

Meningiomas of Pineal Region and Posterior Part of 3rd Ventricle

1962 ◽  
Vol 19 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Ernest Sachs ◽  
Nurhan Avman ◽  
Robert G. Fisher
Keyword(s):  
Posterior Part ◽  
Pineal Region ◽  
3Rd Ventricle

Unilateral Hydrocephalus

1940 ◽  
Vol 86 (363) ◽  
pp. 591-601
Author(s):  
R. M. Stewart
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Spinal Fluid ◽  
Entire Body ◽  
Foramen Of Monro ◽  
Small Aperture ◽  
Partial Closure ◽  
The Third ◽  
Inflammatory Conditions ◽  
Internal Hydrocephalus

A single small aperture connecting each lateral ventricle with the dorsocephalic portion of the third ventricle provides the sole means of escape for cerebro-spinal fluid, and consequently it follows that any interference with its patency will seriously retard the outward flow of ventricular fluid. Complete, or even partial, closure of the foramen leads to a rapid increase in the volume and pressure of imprisoned ventricular fluid so that a condition of internal hydrocephalus is soon established. Usually both foramina are occluded, the hydrocephalus being therefore bilateral and the ventricles more or less symmetrically enlarged. In rare instances, however, only one foramen is obstructed, in which case the dilatation will, of course, be confined to the ipsilateral ventricle. Unilateral hydrocephalus of this obstructive type is commonly caused by inflammatory conditions in the neighbourhood of the foramen, or by pedunculated tumours attached to the choroid plexus which enjoy a degree of movement sufficient to permit intermittent or permanent blockage of the foramen of Monro. It is, however, possible to find examples of unilateral hydrocephalus in which the outflow of cerebro-spinal fluid through the foramen of Monro is unimpeded, and in these the cause of the ventricular dilatation is to be sought in some diseased condition of the cerebral wall which has become so weakened as to be unable to resist even normal ventricular pressure. Such expansion may be either limited to one part of the lateral ventricle, or general, involving the entire body with its horns.

Anatomical Study of the Arachnoid Envelope Over the Pineal Region

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons7-ons15 ◽  
Author(s):  
Qi Song-tao ◽  
Zhang Xi-an ◽  
Fan Jun ◽  
Huang Guang-long ◽  
Pan Jun ◽  
...  
Keyword(s):  
Anterior Part ◽  
Posterior Part ◽  
Anatomical Study ◽  
Pineal Region ◽  
Growth Patterns ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
Arachnoid Membrane ◽  
Pineal Tumors ◽  
Neurovascular Structures

Abstract BACKGROUND: The distribution of the arachnoid membrane and its relationship with the neurovascular structures in the pineal region are still not fully understood. OBJECTIVE: Because the arachnoid membrane has an intimate relationship with the neurovascular structures in the pineal region and it will always be encountered surgically, we attempted to clarify the formation and distribution of the arachnoid envelope over the pineal region (AEPG). METHODS: The formation and distribution of the AEPG and its relationship with the neurovascular structures in the pineal region were examined by anatomic dissection in 20 adult cadaveric formalin-fixed heads. RESULTS: The supratentorial and infratentorial outer arachnoid membranes converged at the tentorial apex and then embraced and ran forward along the vein of Galen to form the AEPG. The AEPG could be divided into 2 parts. Typically, the posterior part of the AEPG enveloped the vein of Galen and the terminal segments of its tributaries, and the anterior part of the AEPG enveloped the suprapineal recess, the pineal gland, and the distal segment of the internal cerebral veins. The compartment demarcated by the AEPG did not communicate with the adjacent subarachnoid cisterns or space. CONCLUSION: Previous knowledge about the AEPG, as well as the superior boundary and the contents of the quadrigeminal cistern, needs to be revised. The arrangement and individual variation of AEPG are important for a better understanding of the various growth patterns of the pineal tumors and the relationship between the tumor and the neurovascular structures in the pineal region.

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