Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy.
Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy.
Adv Tech Stand Neurosurg. 2023;48:207-249. doi: 10.1007/978-3-031-36785-4_8.
The third ventricle is located in the deepest part of the brain and is delimited by both telencephalic and diencephalic structures. Its location makes every surgical procedure inside or around it quite challenging, due to the distance from the surface to the fragility of the neurovascular structures that is necessary to dissect before entering its cavity and to the narrow surgical corridors through which it is necessary to work. Its geometric localization inside the cranial cavity and the anatomical relationship with the interhemispheric fissure offers nevertheless to the surgeon an impressive variety of surgical approaches, which allow to reach every millimeter of the third ventricle lumen. Mastering properly all these approaches requires an impressive anatomical knowledge, the best available technology, and most refined technical skills, making the surgery of the third ventricle a point of excellence in the evolution of each neurosurgeon. The development of neuronavigation and neuroendoscopy has been a revolution in neurosurgery in the last 20 years and offered special advantages for the surgery of the third ventricle. In fact, the narrow corridors of approach make the precision of the neuronavigation and the enlightenment and magnification of the neuroendoscopy especially useful to reach the third ventricle cavity and working inside or around it. This chapter reviews the history of the surgery of the third ventricle and offers an update of the variety of surgical corridors identified and of the technology now available to properly work through them and inside the third ventricle cavity.
第三脑室位于大脑的最深处，由端脑和间脑结构限定。由于距离脑表面的距离以及进入其腔室之前必须解剖的神经血管结构的脆弱性，使得其内部或周围的每一次手术都极具挑战性，而且还需要通过狭窄的手术通道进行操作。它在颅腔内的几何定位以及与大脑两半球间裂的解剖关系为外科医生提供了令人印象深刻的多种手术入路，这些入路可以到达第三脑室腔的每一个毫米。要正确掌握所有这些入路，需要令人印象深刻的解剖学知识、最好的可用技术和最精细的技术技能，使第三脑室手术成为每位神经外科医生发展的卓越领域。神经导航和神经内镜技术的发展是过去 20 年来神经外科的一场革命，为第三脑室手术带来了特殊优势。事实上，狭窄的手术通道使得神经导航的精确性以及神经内镜的照明和放大作用对于到达第三脑室腔和在其内部或周围进行操作特别有用。本章回顾了第三脑室手术的历史，并介绍了目前可用于正确通过这些通道和在第三脑室腔内部进行操作的各种手术通道和技术。
