Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA.
Acta Neurochir (Wien). 2023 Sep;165(9):2421-2434. doi: 10.1007/s00701-023-05697-1. Epub 2023 Jul 7.
To create a high-quality, cadaver-based, operatively oriented resource documenting the anterior transcortical and interhemispheric transcallosal approaches as corridors to the third ventricle targeted towards neurosurgical trainees at all levels.
Two formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic-assisted visualization. Dissections of the transcortical and transcallosal craniotomies with transforaminal, transchoroidal, and interforniceal transventricular approaches were performed. The dissections were documented in a stepwise fashion using three-dimensional photographic image acquisition techniques and supplemented with representative cases to highlight pertinent surgical principles.
The anterior transcortical and interhemispheric corridors afford excellent access to the anterior two-thirds of the third ventricle with varying risks associated with frontal lobe versus corpus callosum disruption, respectively. The transcortical approach offers a more direct, oblique view of the ipsilateral lateral ventricle, whereas the transcallosal approach readily establishes biventricular access through a paramedian corridor. Once inside the lateral ventricle, intraventricular angled endoscopy further enhances access to the extreme poles of the third ventricle from either open transcranial approach. Subsequent selection of either the transforaminal, transchoroidal, or interforniceal routes can be performed through either craniotomy and is ultimately dependent on individual deep venous anatomy, the epicenter of ventricular pathology, and the concomitant presence of hydrocephalus or embryologic cava. Key steps described include positioning and skin incision; scalp dissection; craniotomy flap elevation; durotomy; transcortical versus interhemispheric dissection with callosotomy; the aforementioned transventricular routes; and their relevant intraventricular landmarks.
Approaches to the ventricular system for maximal safe resection of pediatric brain tumors are challenging to master yet represent foundational cranial surgical techniques. We present a comprehensive operatively oriented guide for neurosurgery residents that combines stepwise open and endoscopic cadaveric dissections with representative case studies to optimize familiarity with third ventricle approaches, mastery of relevant microsurgical anatomy, and preparation for operating room participation.
创建一个高质量的、基于尸体的、以手术为导向的资源，记录前皮质和半球间透明隔切开术作为通向第三脑室的通道，针对各级神经外科受训者。
在显微镜放大和内窥镜辅助可视化下对两个福尔马林固定、乳胶注射的标本进行解剖。进行经皮质和经透明隔颅切开术，采用经颅前、经脉络膜和经中间孔的经脑室入路。采用三维摄影图像采集技术分步骤记录解剖过程，并辅以代表性病例，突出相关手术原则。
前皮质和半球间通道可提供到达第三脑室前 2/3 的良好入路，但分别与额叶与胼胝体破坏相关的风险不同。经皮质入路提供了同侧侧脑室更直接、倾斜的视图，而经透明隔入路则通过正中旁通道容易建立双侧脑室入路。一旦进入侧脑室，脑室内角度内窥镜进一步增强了从开颅经颅入路对第三脑室极部的进入。随后选择经颅前、经脉络膜或经中间孔的路线可以通过任何一种颅切开术进行，最终取决于个体深静脉解剖、脑室病变的中心点以及脑积水或胚胎性腔静脉的并存。描述的关键步骤包括定位和皮肤切口；头皮解剖；颅骨瓣抬起；硬脑膜切开术；经皮质与经半球间的解剖与胼胝体切开术；上述经脑室入路；及其相关的脑室内标志。
对于最大限度安全切除小儿脑瘤的脑室系统入路具有挑战性，但代表了基础的颅外科技术。我们为神经外科住院医师提供了一个全面的以手术为导向的指南，结合了分步式开放和内窥镜尸体解剖以及代表性病例研究，以优化对第三脑室入路的熟悉程度、掌握相关显微解剖学知识，并为手术室参与做好准备。
