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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.