Feletti Alberto, Fiorindi Alessandro, Lavecchia Vincenzo, Boscolo-Berto Rafael, Marton Elisabetta, Macchi Veronica, De Caro Raffaele, Longatti Pierluigi, Porzionato Andrea, Pavesi Giacomo
1Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona.
2Department of Neurosciences, Neurosurgical Unit, University of Modena.
J Neurosurg. 2020 Jul 3;135(1):309-317. doi: 10.3171/2020.4.JNS20493. Print 2021 Jul 1.
Despite the technological advancements of neurosurgery, the posterior part of the third ventricle has always been the "dark side" of the ventricle. However, flexible endoscopy offers the opportunity for a direct, in vivo inspection and detailed description of the posterior third ventricle in physiological and pathological conditions. The purposes of this study were to describe the posterior wall of the third ventricle, detailing its normal anatomy and surgical landmarks, and to assess the effect of chronic hydrocephalus on the anatomy of this hidden region.
The authors reviewed the video recordings of 59 in vivo endoscopic explorations of the posterior third ventricle to describe every identifiable anatomical landmark. Patients were divided into 2 groups based on the absence or presence of a chronic dilation of the third ventricle. The first group provided the basis for the description of normal anatomy.
The following anatomical structures were identified in all cases: adytum of the cerebral aqueduct, posterior commissure, pineal recess, habenular commissure, and suprapineal recess. Comparing the 2 groups of patients, the authors were able to detect significant variations in the shape of the adytum of the cerebral aqueduct and in the thickness of the habenular and posterior commissures. Exploration with sodium fluorescein excluded the presence of any fluorescent area in the posterior third ventricle, other than the subependymal vascular network.
The use of a flexible scope allows the complete inspection of the posterior third ventricle. The anatomical variations caused by chronic hydrocephalus might be clinically relevant, in light of the commissure functions.
尽管神经外科技术不断进步，但第三脑室后部一直是脑室的“黑暗区域”。然而，软性内镜为直接在体检查和详细描述生理及病理状态下的第三脑室后部提供了机会。本研究的目的是描述第三脑室后壁，详述其正常解剖结构和手术标志，并评估慢性脑积水对这个隐蔽区域解剖结构的影响。
作者回顾了59例第三脑室后部的体内内镜探查视频记录，以描述每一个可识别的解剖标志。根据第三脑室是否存在慢性扩张将患者分为两组。第一组为正常解剖结构的描述提供了依据。
所有病例均识别出以下解剖结构：大脑导水管内口、后连合、松果体隐窝、缰连合和松果体上隐窝。比较两组患者，作者能够检测到大脑导水管内口形状以及缰连合和后连合厚度的显著差异。荧光素钠探查排除了第三脑室后部除室管膜下血管网络外任何荧光区域的存在。
使用软性内镜可对第三脑室后部进行全面检查。鉴于连合的功能，慢性脑积水引起的解剖变异可能具有临床相关性。
