Abstract
In the last few years, there has been a resurgence of interest in endoscopic third
ventriculostomy as a treatment for obstructive hydrocephalus. Although various techniques
have been used to perform this procedure, not enough emphasis has been placed on the
microanatomical details of the third ventricle and surrounding cisterns in relation
to this procedure. Using a surgical microscope we examined the microsurgical anatomy
of the floor of the third ventricle floor and related subarachnoid cisterns in 20
adult brains using the “immersion technique” in conjunction with microsurgical dissection.
We believe that the optimal place to fenestrate is the midline of the floor of the
third ventricle, behind the infundibular recess and in front of the mammillary bodies,
communicating the third ventricle with the anterior interpeduncular cistern.minimizing
the risk for vascular lesions. Stereotactic third ventriculostomy is a safe and effective
way of re-establishing normal cerebrospinal fluid flow dynamics in selected cases
of obstructive hydrocephalus. However, in an endoscopic exposure only a small portion
of the anatomy can be seen at any one time, and important neurovascular structures
may be located adjacent to the endoscope, but outside of the Visual range of the lens.
A thorough understanding of the microanatomy of the neural and vascular structures
surrounding the third ventricle and related cisterns is essential in order to improve
surgical results avoiding complications.
Key words
Cerebrospinal fluid - Microanatomy - Third ventriculostomy
