Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 14209, USA.
J Neurosurg. 2011 Feb;114(2):446-53. doi: 10.3171/2010.10.JNS101000. Epub 2010 Nov 19.
An opaque (neural) floor of the third ventricle is considered an obstacle to safe penetration of the floor of the third ventricle in endoscopic third ventriculostomy (ETV). The direct technique of endoscopic coring ("cookie cut") of the opaque (neural) floor of the third ventricle is described in 41 cases among a total of 101 consecutive adult ETVs.
A 0° endoscope in a 4.6-mm irrigating sheath was used to press and core ("cookie cut") a section of the tuber cinereum, thereby exposing the underlying membranes and vasculature. Thereafter, the endoscopic apparatus was used to penetrate the membrane into the prepontine space.
Among 101 consecutive ETVs performed in adults, there were 41 instances of an opaque floor in which the coring technique was used. The basilar artery (BA) complex was in the intended path of penetration in 13 cases. There were no perioperative deaths or vascular injuries. No cases were aborted because of the opaque floor or the configuration of the BA complex. The clinical success rate in the opaque floor group was 80% (33 of 41 patients).
An opaque (neural) floor is frequently seen in adults during ETV. Removing the floor by the core ("cookie cut") method is a safe means of revealing the underlying BA complex and membranous structures prior to penetration into the prepontine cistern. On occasion, the BA complex may be in the path of penetration, and one can maneuver the endoscope to displace the vasculature to successfully accomplish the ETV.
第三脑室底部不透明（神经）被认为是内镜第三脑室造瘘术（ETV）中安全穿透第三脑室底部的障碍。本文介绍了在总共 101 例连续成人 ETV 中，有 41 例采用内镜核心（“饼干切割”）技术处理不透明（神经）第三脑室底部。
使用 0°内镜和 4.6mm 冲洗鞘，按压并核心（“饼干切割”）一部分灰结节，从而暴露下方的膜和血管。然后，使用内镜器械穿透该膜进入桥前池。
在 101 例连续进行的成人 ETV 中，有 41 例出现不透明底部，使用了核心技术。基底动脉（BA）复合体在计划穿透路径上的有 13 例。无围手术期死亡或血管损伤。没有因为不透明底部或 BA 复合体的结构而中止的病例。不透明底部组的临床成功率为 80%（41 例患者中有 33 例）。
在 ETV 中，成人中经常出现不透明（神经）底部。通过核心（“饼干切割”）方法去除底部是一种安全的方法，可以在穿透桥前池之前揭示下方的 BA 复合体和膜结构。有时，BA 复合体可能在穿透路径上，可以通过操纵内镜来移动血管，成功完成 ETV。
