Comparative Anatomical Study on Operability in Surgical Approaches to the Anterior Part of the Third Ventricle

World Neurosurg. 2016 Nov;95:457-463. doi: 10.1016/j.wneu.2016.08.073. Epub 2016 Aug 24.


Background: Surgery of the third ventricle still represents a challenge in modern neurosurgery. To optimize the surgical planning, some aspects, related to ventricular anatomy, have to be taken into consideration. An operability score could represent a preoperative tool to evaluate these variables to choose a tailored surgical approach.

Methods: We compared the transcallosal transforaminal approach and the combined interhemispheric subcommissural translamina terminalis approach (CISTA) to the anterior part of the third ventricle, applying the operability score.

Results: Compared with the transcallosal transforaminal approach, the CISTA provides a statistically significant improvement in terms of depth of surgical field, surgical angle of attack, and maneuverability arc considering as 4 approach-related critical structures: the optic chiasm (P value: <0.0001, <0.0001, <0.0001, respectively), the anterior commissure (P value: <0.0001, <0.0001, <0.0001 respectively), the tuber cinereum (P value: <0.0001, 0.0224, 0.0173), and the interthalamic adhesion (P value: 0.2917, <0.0001, <0.0001 respectively).

Conclusions: Tumors originating from the anterosuperior part of the third ventricle can be easily approached through a transcallosal transforaminal route, whereas lesions arising from the anteroinferior portion of the third ventricle might be safely and effectively approached through the CISTA.

Keywords: Corpus callosum; Lamina terminalis; Operability score; Optic chiasm; Third ventricle.

Publication types

  • Comparative Study

MeSH terms

  • Cadaver
  • Cerebral Ventricle Neoplasms / surgery*
  • Corpus Callosum / anatomy & histology*
  • Humans
  • Hypothalamus / anatomy & histology*
  • Microsurgery / methods
  • Neurosurgical Procedures / methods*
  • Organ Size
  • Third Ventricle / anatomy & histology
  • Third Ventricle / surgery*