Üçüncü ventriküle anterior interhemisferik transkoroidal yaklaşımın mikrocerrahi ve endoskopik anatomisi ve limitasyonlar
Abstract
Amaç: Derin ve kompleks bir anatomiye sahip olan üçüncü ventrikül lezyonların cerrahisi bu özelliklerinden dolayı çeşitli zorluklar barındırır. Bu bölgeye güvenli erişim, kritik nöral ve vasküler yapıları koruyarak cerrahi koridor oluşturmakla mümkündür. Bu çalışma üçüncü ventriküle anterior interhemisferik transkoroidal yaklaşımın mikrocerrahi anatomisinin kapsamlı bir incelemesini sunarken endoskop kullanımının mikrocerrahi diseksiyona sağladığı avantajları ile yaklaşımın limitasyonlarını ortaya koymayı amaçlamaktadır. Gereç ve Yöntem: Silikon enjekte edilmiş, formalinle sabitlenmiş iki yetişkin insan kadavra kafası yüksek çözünürlüklü mikroskopi ve rijit endoskopi altında diseke edildi. Üçüncü ventriküle erişmek için anterior interhemisferik transkoroidal yaklaşım uygulandı. Yaklaşımın her aşaması mikroskop ve endoskop altında fotoğraflandı ve karşılaştırılmalı olarak analiz edildi.
Bulgular: Transkoroidal koridor üçüncü ventriküle güvenilir bir erişim sağladı. Forniks gibi kritik anatomik yapıların korunmasına imkan sağladığı görüldü. Endoskop kullanımının ise, posterior üçüncü ventrikül tabanının ve internal serebral ven bölgesine görüntü hakimiyetini arttırdığı ortaya kondu. Aynı zamanda nöroendoskopi ile beyin ekartasyonu en aza indirildi.
Sonuç: Anterior interhemisferik transkoroidal yaklaşım, endoskopik kullanımı ile, üçüncü ventriküle güvenli bir cerrahi koridor sağlamaktadır. Ayrıca kritik yapıların korunabilmesi güvenli ve modern bir yaklaşım olarak kabul edilmesini sağlar. Mikrocerrahi prensiplerin gelişmiş endoskopik yöntemlerle sentezi, üçüncü ventriküle yönelik cerrahinin etkinliğini en üst düzeye çıkarırken komplikasyon riskini en aza indirir.
Supporting Institution
Bu araştırma için herhangi bir maddi destek alınmamıştır.
Thanks
Bu çalışmanın kadavra çalışmasının gerçekleştirilebilmesi için teknik ve fiziki imkanları sağlayan İstanbul Üniversitesi-Cerrahpaşa Endomikronöroşirürji Laboratuvarı sorumlusu Prof. Dr. Necmettin Tanrıöver’e teşekkür ederim
References
- Rhoton AL. The lateral and third ventricles. Neurosurgery. 2002;51(4 Suppl):S207-71.
- Brockmeyer D. Techniques of endoscopic third ventriculostomy. Neurosurg Clin N Am. 2004;15(1):51-9.
- Patel PG, Cohen-Gadol AA, Mercier P, Boop FA, Klimo P. The posterior transcallosal approach to the pineal region and posterior third ventricle: intervenous and paravenous variants. Oper Neurosurg. 2017;13(1):77-88.
- Kriss TC, Kriss VM. History of the operating microscope: from magnifying glass to microneurosurgery. Neurosurgery. 1998;42(4):899-907.
- Dang DD, Rechberger JS, Leonel LCPC, Rindler RS, Nesvick CL, Graepel S, et al. Anatomical step-by-step dissection of common approaches to the third ventricle for trainees. Acta Neurochir (Wien). 2023;165(9):2421-34.
- Rutledge C, Jonzzon S, Winkler EA, Hetts SW, Abla AA. Transcortical transventricular transchoroidal-fissure approach to distal fusiform hyperplastic anterior choroidal artery aneurysms. Br J Neurosurg. 2023;37(4):723-7.
- Certo F, Toccaceli G, Altieri R, Barbagallo GM V. Thalamomesencephalic cavernoma: anterior transcallosal transchoroidal approach. Neurosurg Focus Video. 2019;1(1):V20.
- Akiyama O, Matsushima K, Gungor A, Matsuo S, Goodrich DJ, Tubbs RS, et al. Microsurgical and endoscopic approaches to the pulvinar. J Neurosurg. 2017;127(3):630-45.
- Serra C, Türe U. The extreme anterior interhemispheric transcallosal approach for pure aqueduct tumors: surgical technique and case series. Neurosurg Rev. 2022;45(1):499-505.
- Vásquez M, Saavedra LJ, García HH, Apaza A, Caucha Y, Medina JE, et al. Transventricular endoscopic approach to the anterior interhemispheric fissure for neurocysticercosis: illustrative cases. J Neurosurg Case Lessons.2022;4(18):CASE22218.
- Anetsberger S, Gonzalez-Lopez P, Elsawaf Y, Lucifero AG, Luzzi S, Elbabaa SK. Interhemispheric approach. Acta Biomed. 2021;92:1-8.
- Bozkurt B, Yağmurlu K, Belykh E, Tayebi Meybodi A, Staren MS, Aklinski JL, et al. Quantitative anatomic analysis of the transcallosal-transchoroidal and transcallosal-subchoroidal approaches to the floor of the third ventricle: an anatomic study. World Neurosurg. 2018;118:219-29.
- Wen HT, Rhoton AL, de Oliveira E. Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application. Neurosurgery. 1998;42(6):1205-17.
- Otero-Fernández P, Abarca-Olivas J, González-López P, Martorell-Llobregat C, Flores-Justa A, Villena-Martín M, et al. Endoscopic approaches to the posterior wall of the third ventricle: an anatomical comparison. Clin Neurol Neurosurg. 2024;245:108511.
- Tirado-Caballero J, Rivero-Garvía M, González-Pombo M, Cárdenas-Ruiz-Valdepeñas E, Kaen A, Márquez-Rivas J. Fully endoscopic transforaminal–transchoroidal approach for tectal area tumor removal. World Neurosurg.2020;137:164-72.
Microsurgical and endoscopic anatomy and limitations of the anterior interhemispheric transcoroidal approach to the third ventricle
Abstract
Aim: The surgery of third ventricle lesions, which have a deep and complex anatomy, presents various challenges due to these characteristics. Safe access to this region is possible by creating a surgical corridor while preserving critical neural and vascular structures. This article provides a comprehensive review of the microsurgical anatomy of the anterior interhemispheric transchoroidal approach to the third ventricle, while presenting the advantages of endoscope use in microsurgical dissection and the limitations of this approach.
Materials and Methods: Two silicone-injected, formalin-fixed adult human cadaveric heads were dissected under high-resolution microscopy and rigid endoscopy. An anterior interhemispheric transchoroidal approach was used to access the third ventricle. Each stage of the approach was photographed under microscope and endoscope and analyzed comparatively.
Results: The transcoroidal corridor provided reliable access to the third ventricle. Preservation of critical anatomical structures such as the fornix was demonstrated to provide a wide surgical corridor to the lateral and third ventricle. Endoscopy significantly improved visualization of the posterior third ventricular floor and internal cerebral veins compared with microscopy alone. At the same time, brain exclusion was minimized with neuroendoscopy. Conclusion: The anterior interhemispheric transchoroidal approach, when enhanced with endoscopic guidance, provides a safe surgical corridor to the third ventricle. It also offers a safe and modern alternative approach with reduced risk to critical structures. The synthesis of microsurgical principles with advanced endoscopy represents a significant advance in minimizing invasiveness while maximizing the safety and efficacy of third ventricle surgery.
References
- Rhoton AL. The lateral and third ventricles. Neurosurgery. 2002;51(4 Suppl):S207-71.
- Brockmeyer D. Techniques of endoscopic third ventriculostomy. Neurosurg Clin N Am. 2004;15(1):51-9.
- Patel PG, Cohen-Gadol AA, Mercier P, Boop FA, Klimo P. The posterior transcallosal approach to the pineal region and posterior third ventricle: intervenous and paravenous variants. Oper Neurosurg. 2017;13(1):77-88.
- Kriss TC, Kriss VM. History of the operating microscope: from magnifying glass to microneurosurgery. Neurosurgery. 1998;42(4):899-907.
- Dang DD, Rechberger JS, Leonel LCPC, Rindler RS, Nesvick CL, Graepel S, et al. Anatomical step-by-step dissection of common approaches to the third ventricle for trainees. Acta Neurochir (Wien). 2023;165(9):2421-34.
- Rutledge C, Jonzzon S, Winkler EA, Hetts SW, Abla AA. Transcortical transventricular transchoroidal-fissure approach to distal fusiform hyperplastic anterior choroidal artery aneurysms. Br J Neurosurg. 2023;37(4):723-7.
- Certo F, Toccaceli G, Altieri R, Barbagallo GM V. Thalamomesencephalic cavernoma: anterior transcallosal transchoroidal approach. Neurosurg Focus Video. 2019;1(1):V20.
- Akiyama O, Matsushima K, Gungor A, Matsuo S, Goodrich DJ, Tubbs RS, et al. Microsurgical and endoscopic approaches to the pulvinar. J Neurosurg. 2017;127(3):630-45.
- Serra C, Türe U. The extreme anterior interhemispheric transcallosal approach for pure aqueduct tumors: surgical technique and case series. Neurosurg Rev. 2022;45(1):499-505.
- Vásquez M, Saavedra LJ, García HH, Apaza A, Caucha Y, Medina JE, et al. Transventricular endoscopic approach to the anterior interhemispheric fissure for neurocysticercosis: illustrative cases. J Neurosurg Case Lessons.2022;4(18):CASE22218.
- Anetsberger S, Gonzalez-Lopez P, Elsawaf Y, Lucifero AG, Luzzi S, Elbabaa SK. Interhemispheric approach. Acta Biomed. 2021;92:1-8.
- Bozkurt B, Yağmurlu K, Belykh E, Tayebi Meybodi A, Staren MS, Aklinski JL, et al. Quantitative anatomic analysis of the transcallosal-transchoroidal and transcallosal-subchoroidal approaches to the floor of the third ventricle: an anatomic study. World Neurosurg. 2018;118:219-29.
- Wen HT, Rhoton AL, de Oliveira E. Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application. Neurosurgery. 1998;42(6):1205-17.
- Otero-Fernández P, Abarca-Olivas J, González-López P, Martorell-Llobregat C, Flores-Justa A, Villena-Martín M, et al. Endoscopic approaches to the posterior wall of the third ventricle: an anatomical comparison. Clin Neurol Neurosurg. 2024;245:108511.
- Tirado-Caballero J, Rivero-Garvía M, González-Pombo M, Cárdenas-Ruiz-Valdepeñas E, Kaen A, Márquez-Rivas J. Fully endoscopic transforaminal–transchoroidal approach for tectal area tumor removal. World Neurosurg.2020;137:164-72.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Brain and Nerve Surgery (Neurosurgery), Anatomy |
| Journal Section | Research Article |
| Authors | |
| Submission Date | September 21, 2025 |
| Acceptance Date | January 13, 2026 |
| Publication Date | March 9, 2026 |
| DOI | https://doi.org/10.19161/etd.1788261 |
| IZ | https://izlik.org/JA93KD69ZS |
| Published in Issue | Year 2026 Volume: 65 Issue: 1 |
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