Leone Augusto, Carbone Francesco, Corrivetti Francesco, Morello Alberto, Corvino Sergio, Colamaria Antonio, Iaconetta Giorgio, Angileri Filippo Flavio, Spetzger Uwe, de Notaris Matteo
Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy; Department of Neurosurgery-Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Faculty of Human Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy; Department of Neurosurgery-Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Division of Neurosurgery, Università degli Studi di Foggia, Foggia, Italy.
World Neurosurg. 2025 Jul;199:124062. doi: 10.1016/j.wneu.2025.124062. Epub 2025 May 12.
The telovelar approach provides access to the caudal two-thirds of the fourth ventricle without requiring vermian splitting. Indeed, the traditional microsurgical approach is often limited by a restricted cranial angle of attack and visualization, making it challenging to evaluate the patency of the aqueduct. To address this limitation, resection of the posterior arch of C1 is frequently performed. This study aims to describe and evaluate the feasibility of a full-endoscopic, retractorless, trans-Magendie approach to the inferior third of the fourth ventricle, avoiding removal of the posterior arch of C1 through a minimally invasive burr-hole suboccipital craniotomy.
Four formalin-fixed, injected cadaveric heads were investigated. A step-by-step anatomic description of the proposed approach is provided.
Adequate cranial and lateral visualization of the aqueduct and fourth ventricle floor was achieved without removing the posterior arch of C1.
The full-endoscopic trans-Magendie approach enables adequate visualization of the inferior two-thirds of the fourth ventricle and the caudalmost portion of the aqueduct while avoiding the need for a C1 laminectomy and significantly reducing the craniotomy size.
经小脑延髓池入路可进入第四脑室尾侧的三分之二，无需切开小脑蚓部。实际上，传统的显微手术入路常常受到颅骨入路角度受限和视野的限制，使得评估导水管的通畅性具有挑战性。为解决这一局限性，常进行第一颈椎后弓切除术。本研究旨在描述和评估一种全内镜、无需牵开器的经马根迪孔入路至第四脑室下三分之一的可行性，通过微创枕下颅骨钻孔术避免切除第一颈椎后弓。
研究了4个用福尔马林固定、注射过的尸体头部。提供了所提议入路的逐步解剖描述。
在未切除第一颈椎后弓的情况下，实现了对导水管和第四脑室底部充分的颅侧和外侧视野。
全内镜经马根迪孔入路能够充分观察第四脑室下三分之二和导水管最尾端部分，同时避免了第一颈椎椎板切除术的需要，并显著减小了颅骨切开术的大小。
