Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle

OBJECTIVEAccess to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle. However, the fornix column limits the exposure of the anterior region of the third ventricle. There is evidence that the unilateral section of the fornix column has little effect on cognitive function. This study compared the anatomical exposure afforded by the transforniceal-transchoroidal approach with that of the transchoroidal approach. In addition, a morphometric evaluation of structures that are relevant to and common in the 2 approaches was performed.METHODSThe anatomical exposure provided by the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches was compared in 8 fresh cadavers, using a neuronavigation system. The working area, microsurgical exposure area, and angular exposure on the longitudinal and transversal planes of 2 anatomical targets (tuber cinereum and cerebral aqueduct) were compared. Additionally, the thickness of the right frontal lobe parenchyma, thickness of the corpus callosum trunk, and longitudinal diameter of the interventricular foramen were measured. The values obtained were submitted to statistical analysis using the Wilcoxon test.RESULTSIn the quantitative evaluation, compared with the transchoroidal approach, the transforniceal-transchoroidal approach provided a greater mean working area (transforniceal-transchoroidal 150 ± 11 mm2; transchoroidal 121 ± 8 mm2; p < 0.05), larger mean microsurgical exposure area (transforniceal-transchoroidal 101 ± 9 mm2; transchoroidal 80 ± 5 mm2; p < 0.05), larger mean angular exposure area on the longitudinal plane for the tuber cinereum (transforniceal-transchoroidal 71° ± 7°; transchoroidal 64° ± 6°; p < 0.05), and larger mean angular exposure area on the longitudinal plane for the cerebral aqueduct (transforniceal-transchoroidal 62° ± 6°; transchoroidal 55° ± 5°; p < 0.05). No differences were observed in angular exposure along the transverse axis for either anatomical target (tuber cinereum and cerebral aqueduct; p > 0.05). The mean thickness of the right frontal lobe parenchyma was 35 ± 3 mm, the mean thickness of the corpus callosum trunk was 10 ± 1 mm, and the mean longitudinal diameter of the interventricular foramen was 4.6 ± 0.4 mm. In the qualitative assessment, it was noted that the transforniceal-transchoroidal approach led to greater exposure of the third ventricle anterior region structures. There was no difference between approaches in the exposure of the structures of the middle and posterior region.CONCLUSIONSThe transforniceal-transchoroidal approach provides greater surgical exposure of the third ventricle anterior region than that offered by the transchoroidal approach. In the population studied, morphometric analysis established mean values for anatomical structures common to both approaches.

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Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle

Journal of Neurosurgery ◽

10.3171/2016.8.jns16403.test ◽

2016 ◽

pp. 1-10

Author(s):

João Luiz Vitorino Araujo ◽

José C. E. Veiga ◽

Hung Tzu Wen ◽

Almir F. de Andrade ◽

Manoel J. Teixeira ◽

...

Keyword(s):

Corpus Callosum ◽

Third Ventricle ◽

Anterior Region ◽

Cerebral Aqueduct ◽

Tuber Cinereum ◽

The Third ◽

Longitudinal Plane ◽

The Mean ◽

The Right ◽

Longitudinal Diameter

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Effects of melanin-concentrating hormone on licking microstructure and brief-access taste responses

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00143.2006 ◽

2006 ◽

Vol 291 (5) ◽

pp. R1265-R1274 ◽

Cited By ~ 15

Author(s):

John-Paul Baird ◽

Catalina Rios ◽

Nora Elizabeth Gray ◽

Caroline Elizabeth Walsh ◽

Shannon Glenora Fischer ◽

...

Keyword(s):

Third Ventricle ◽

Taste Stimulus ◽

Water Solutions ◽

The Third ◽

Sucrose Solutions ◽

Quinine Hydrochloride ◽

Inhibitory Feedback ◽

Melanin Concentrating Hormone ◽

Taste Evaluation ◽

The Mean

The effects of intracerebroventricular application of melanin-concentrating hormone (MCH) on licking for sucrose, quinine hydrochloride (QHCl), and water solutions were evaluated in two experiments. In experiment 1, rats received 90-min access to sucrose and water solutions after MCH or vehicle microinjection to the third ventricle (3V). MCH increased intake largely through increases in the rate of licking early in the meal and in the mean duration of lick bursts, suggesting an effect on gustatory evaluation. Therefore, in experiment 2, brief access tests were used with a series of sucrose and QHCl concentrations to behaviorally isolate the effects of intracerebroventricular MCH on gustatory evaluation. MCH uniformly increased licking for all sucrose solutions, water, and weak concentrations of QHCl; however, it had no effect on licking for the strongest concentrations of QHCl, which were generally avoided under control conditions. Thus MCH did not produce nonspecific increases in oromotor activity, nor did it change the perceived intensity of the tastants. We conclude that MCH enhanced the gain of responses to normally accepted stimuli at a phase of processing after initial gustatory detection and after the decision to accept or reject the taste stimulus. A comparison of 3V NPY and MCH effects on licking microstructure indicated that these two peptides increased intake via dichotomous behavioral processes; although NPY suppressed measures associated with inhibitory feedback from the gut, MCH appeared instead to enhance measures associated with hedonic taste evaluation.

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Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position

Operative Neurosurgery ◽

10.1093/ons/opy324 ◽

2018 ◽

Vol 17 (2) ◽

pp. 143-148 ◽

Cited By ~ 1

Author(s):

Alberto Feletti ◽

Riccardo Stanzani ◽

Matteo Alicandri-Ciufelli ◽

Giuliano Giliberto ◽

Matteo Martinoni ◽

...

Keyword(s):

Prone Position ◽

Posterior Fossa ◽

Fourth Ventricle ◽

Blood Clot ◽

Third Ventricle ◽

Cerebral Aqueduct ◽

Posterior Fossa Surgery ◽

The Third ◽

Blood Clots ◽

Surgical Field

AbstractBACKGROUNDDuring surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.OBJECTIVETo illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris.METHODSWe report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker.RESULTSA large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess.CONCLUSIONWe describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training.

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Hypothalamic Hamartoma in a Dog

Veterinary Pathology ◽

10.1177/030098587701400206 ◽

1977 ◽

Vol 14 (2) ◽

pp. 138-145 ◽

Cited By ~ 12

Author(s):

R. W. Cook

Keyword(s):

Cerebrospinal Fluid ◽

Third Ventricle ◽

Fluid Pressure ◽

Hypothalamic Hamartoma ◽

Tuber Cinereum ◽

Mammillary Bodies ◽

Spongiform Change ◽

The Third ◽

The Brain ◽

Rostral Part

A 10-month-old female, Wire-haired Pointing Griffon dog had a hamartoma of the hypothalamus. Episodes of sudden flaccid collapse had increased in frequency and duration for 7 months. Cerebrospinal fluid pressure was normal. A flat, pedunculated mass, 2.5×3.0×0.9 cm, covered the brain stem between the pituitary gland and pons. Its 1.2-cm-diameter connection to the hypothalamus obliterated the mammillary bodies and extended to the tuber cinereum, distorting the hypothalamus and displacing the third ventricle which also divided the rostral part of the mass. The tissue of the hamartoma resembled gray matter with bullous cytoplasmic vacuolation of many neurons, spongiform change, gemistocytosis and microscopic foci of calcification.

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Effects of intraventricular infusion of corticotropin-releasing factor on VMH-lesioned obese rats

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1989.256.3.r751 ◽

1989 ◽

Vol 256 (3) ◽

pp. R751-R756 ◽

Cited By ~ 4

Author(s):

K. Arase ◽

N. S. Shargill ◽

G. A. Bray

Keyword(s):

Food Intake ◽

Third Ventricle ◽

Mean Value ◽

Corticotropin Releasing Factor ◽

Interscapular Brown Adipose Tissue ◽

The Third ◽

Significant Stimulation ◽

Brown Adipose ◽

The Mean ◽

Intraventricular Infusion

Corticotropin-releasing factor (CRF) has been administered into the third ventricle of sham-operated and ventromedial hypothalamic (VMH)-lesioned rats in acute and chronic experiments. After a single 5-microgram injection of CRF, there was an acute reduction of food intake in both sham-operated and VMH-lesioned rats that persisted for 3 h. The effect was still present in the VMH-lesioned rats between 3 and 6 h but had dissipated in the sham-operated controls. Guanosine 5'-diphosphate (GDP) binding to mitochondria from interscapular brown adipose tissue was used as an index of thermogenic activity in this tissue. In 21-h food-deprived rats, GDP binding was significantly lower in VMH-lesioned than in sham-operated animals. Although the mean increase in sham-operated animals was increased, this was not significantly different from saline-injected controls. In the VMH-lesioned rats, however, CRF acutely increased GDP binding to values not different than those of the sham-operated controls. Serum corticosterone was significantly lower in the VMH-lesioned rats, but both groups showed a significant stimulation by CRF during a 7-day infusion of CRF (4.8 micrograms/day) into the third ventricle. Food intake was significantly depressed in the VMH-lesioned animals that received CRF, from values of 35 g/day to approximately 25 g/day. Body weight showed a slow steady decrease, having fallen by nearly 15 g at the end of the 7-day infusion period. In contrast the mean value in the VMH-lesioned controls had significantly higher in CRF-infused animals.(ABSTRACT TRUNCATED AT 250 WORDS)

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Combined interhemispheric translamina terminalis and pterional approach for a dorsum sellae meningioma

Neurosurgical FOCUS ◽

10.3171/2017.10.focusvid.17302 ◽

2017 ◽

Vol 43 (videosuppl2) ◽

pp. V4

Author(s):

Shinya Suematsu ◽

Hideaki Ono ◽

Tomohiro Inoue ◽

Akira Tamura

Keyword(s):

Surgical Technique ◽

Third Ventricle ◽

Pituitary Stalk ◽

Maximum Diameter ◽

Pterional Approach ◽

The Third ◽

Link Type ◽

The Right

This video demonstrates a surgical technique of resecting dorsum sellae meningioma using a combined interhemispheric translamina terminalis approach and pterional approach with clinoidectomy. The tumor, 5 cm in maximum diameter, originated from the dorsum sellae, compressed the third ventricle and the midbrain, and displaced the pituitary stalk ventrally. Feeding arteries of the tumor were bilateral meningohypophyseal trunks, mainly from the right side. The authors performed devascularization of the tumor via a right pterional approach following frontotemporal craniotomy, and debulking of the tumor via an interhemispheric translamina terminalis approach following bifrontal craniotomy. These procedures with two separate craniotomies enabled safe and effective resection of the tumor.The video can be found here: https://youtu.be/DEnKOC5zQ_M.

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Attenuation of lipopolysaccharide anorexia by antagonism of caudal brain stem but not forebrain GLP-1-R

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00163.2004 ◽

2004 ◽

Vol 287 (5) ◽

pp. R1190-R1193 ◽

Cited By ~ 38

Author(s):

Harvey J. Grill ◽

Jill S. Carmody ◽

L. Amanda Sadacca ◽

Diana L. Williams ◽

Joel M. Kaplan

Keyword(s):

Food Intake ◽

Brain Stem ◽

Third Ventricle ◽

Cerebral Aqueduct ◽

Relative Importance ◽

The Third ◽

Native Peptide ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Rule Out

The central glucagon-like peptide-1 (GLP-1) system has been implicated in the control of feeding behavior. Here we explore GLP-1 mediation of the anorexic response to administration of systemic LPS and address the relative importance of caudal brain stem and forebrain GLP-1 receptor (GLP-1-R) for the mediation of the response. Fourth-intracerebroventricular delivery of the GLP-1-R antagonist exendin-(9–39) (10 μg) did not itself affect food intake in the 24 h after injection but significantly attenuated the otherwise robust (∼60%) reduction in food intake obtained after LPS (100 μg/kg) treatment. This result highlights a role for caudal brain stem GLP-1-R in the mediation of LPS anorexia but does not rule out the possibility that forebrain receptors also contribute to the response. Forebrain contribution was addressed by delivery of the GLP-1-R antagonist to the third ventricle with the caudal flow of cerebrospinal fluid blocked by occlusion of the cerebral aqueduct. Exendin-(9–39) delivery thus limited to forebrain did not attenuate the anorexic response to LPS. These data suggest that LPS anorexia is mediated, in part, by release of the native peptide acting on GLP-1-R within the caudal brain stem.

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Frontal dermoid cyst coexisting with suprasellar craniopharyngioma: a spectrum of ectodermally derived epithelial-lined cystic lesions?

Neurosurgical FOCUS ◽

10.3171/2016.8.focus16238 ◽

2016 ◽

Vol 41 (6) ◽

pp. E16 ◽

Cited By ~ 1

Author(s):

Hussam Abou-Al-Shaar ◽

Muhammad M. Abd-El-Barr ◽

Hasan A. Zaidi ◽

Eleanor Russell-Goldman ◽

Rebecca D. Folkerth ◽

...

Keyword(s):

Frontal Lobe ◽

Dermoid Cyst ◽

Histopathological Examination ◽

Third Ventricle ◽

Residual Tumor ◽

Subtotal Resection ◽

Cystic Lesions ◽

Frontal Lesion ◽

The Third ◽

The Right

There is a wide group of lesions that may exist in the sellar and suprasellar regions. Embryologically, there is varying evidence that many of these entities may in fact represent a continuum of pathology deriving from a common ectodermal origin. The authors report a case of a concomitant suprasellar craniopharyngioma invading the third ventricle with a concurrent frontal lobe cystic dermoid tumor. A 21-year-old man presented to the authors' service with a 3-day history of worsening headache, nausea, vomiting, and blurry vision. Magnetic resonance imaging depicted a right frontal lobe lesion associated with a separate suprasellar cystic lesion invading the third ventricle. The patient underwent a right pterional craniotomy for resection of both lesions. Gross-total resection of the right frontal lesion was achieved, and subtotal resection of the suprasellar lesion was accomplished with some residual tumor adherent to the walls of the third ventricle. Histopathological examination of the resected right frontal lesion documented a diagnosis of dermoid cyst and, for the suprasellar lesion, a diagnosis of adamantinomatous craniopharyngioma. The occurrence of craniopharyngioma with dermoid cyst has not been reported in the literature before. Such an association might indeed suggest the previously reported hypothesis that these lesions represent a spectrum of ectodermally derived epithelial-lined cystic lesions.

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Transcranial Sonographic Assessment of the Third Ventricle in Neuro-ICU Patients to Detect Hydrocephalus: A Diagnostic Reliability Pilot Study

10.21203/rs.3.rs-127677/v1 ◽

2020 ◽

Author(s):

Remy WIDEHEM ◽

Paul Bory ◽

Frederic Greco ◽

Frederique Pavillard ◽

Kevin Challard ◽

...

Keyword(s):

Learning Curve ◽

Gold Standard ◽

Third Ventricle ◽

Transcranial Sonography ◽

Absolute Difference ◽

Diameter Measurement ◽

Icu Patients ◽

The Third ◽

Brain Injured ◽

The Right

Abstract BACKGROUND: Transcranial sonography is a point of care tool recommended in intensive care units (ICU) to monitor brain injured patients. OBJECTIVE: To assess feasibility and reliability of the third ventricle (V3) diameter measurement using transcranial sonography (TCS) compared to brain computedtomography (CT), the gold standard measurement, and to measure the TCS learning curve. METHODS: prospective study, in a 16-bed neurological ICU in an academic hospital. We included consecutive brain injured adult patient, who required a brain CT and TCS monitoring. V3 diameter was blindly measured by TCS and CT. MAIN OUTCOME MEASURES: V3 diameter measured by TCS and CT: Intra-class correlation coefficient (ICC) and Bland-Altman plot were used to assess the reliability and agreement between V3 measurements. Diagnosis performance of the V3 diameter using TCS to detect hydrocephalus was measured. Absolute difference between V3 measurement by residents and experts was measured consecutively to assess the learning curve. RESULTS: Among the 100 patients included in the study, V3 diameter could be assessed in 87 patients from at least one side of the skull. Both temporal windows were available in 70 patients. The ICC between V3 diameter measured by TCS and CT was 0.90 [95% Confidence-Interval 0.84-0.93] on the right side, and 0.92 [0.880.95] on the left side. In Bland-Altman analysis, mean difference, standard deviation, 95% limits of agreement were 0.36, 1.52, -2.71 to 3.45 mm, respectively, on the right side; 0.25, 1.47, -2.71 to 3.21 mm, respectively, on the left side. Among the 35 patients with hydrocephalus, V3 diameters could be measured by TCS in 31 patients from at least one side. Hydrocephalus was respectively excluded, confirmed, or inconclusive using TCS in 40, 29 and 31% of the 87 assessable patients. After 5 measurements, every resident reached a satisfactory measurement compared to the expert operator, defined by a mean absolute difference < 1 mm. CONCLUSION: TCS allows rapid, simple and reliable V3 diameter measurement compared with the gold standard in neuro-ICU patients. Aside from sparing irradiating procedures and transfers to the radiology department, it may especially increase close patient monitoring to detect clinically occult hydrocephalus earlier. Further studies are needed to measure potential clinical benefit. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02830269. Registered 17 July 2016, https://www.clinicaltrials.gov/ct2/show/NCT02830269?term=NCT02830269&draw=2&rank=1

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A remark on some extensions of the mean-variance portfolio selection models

Risk Management Magazine ◽

10.47473/2020rmm0097 ◽

2021 ◽

Vol 16 (3) ◽

pp. 26-34

Author(s):

Enrico Moretto ◽

Keyword(s):

Portfolio Management ◽

Proper Time ◽

Research Question ◽

The Third ◽

Management Techniques ◽

The Common ◽

The Mean ◽

Mean Variance Portfolio ◽

The Right ◽

Mean Variance

Quantitative risk management techniques should prove their efficacy when financially turbulent periods are about to occur. Along the common saying “who needs an umbrella on a sunny day?”, a theoretical model is really helpful when it carries the right suggestion at the proper time, that is when markets start behaving hecticly. The beginning of the third decade of the 21st century carried along a turmoil that severely affected worldwide economy and changed it, probably for good. A consequent and plausible research question could be this: which financial quantitative approaches can still be considered reliable? This article tries to partially answer this question by testing if the mean-variance selection model (Markowitz [16], [17]) and some of his refinements can provide some useful hints in terms of portfolio management.

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