Abstract
Objective Surgical access to the third ventricle can be achieved through various corridors
depending on the location and extent of the lesion; however, traditional transcranial
approaches risk damage to multiple critical neural structures.
Methods Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV)
was surgically simulated in eight cadaveric heads. Fiber dissections were additionally
performed within the third ventricle along the endoscopic route. Additionally, we
present a case of ERTV in a patient with craniopharyngioma extending into the third
ventricle.
Results The ERTV allowed adequate intraventricular visualization along the third ventricle.
The extracranial step of the surgical corridor included a bony window in the sellar
floor, tuberculum sella, and the lower part of the planum sphenoidale. ERTV provided
an intraventricular surgical field along the foramen of Monro to expose an area bordered
by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly,
posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius
centered posterior inferiorly.
Conclusion The third ventricle can safely be accessed through ERTV either above or below the
pituitary gland. ERTV provides a wide exposure of the third ventricle through the
tuber cinereum and offers access to the anterior part as far as the anterior commissure
and precommissural part of fornix and the whole length of the posterior part. Endoscopic
ERTV may be a suitable alternative to transcranial approaches to access the third
ventricle in selected patients.
Keywords
craniopharyngioma - endoscopy - skull base surgery - tuber cinereum - third ventricle
- reverse third ventriculostomy
