approaches to 3rd ventricle
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This document discusses different approaches to the third ventricle for removing common tumors. It outlines tumors that are located in the anterior 1/3 and posterior 1/3 of the third ventricle. It then describes the anterior, lateral, posterior, and transnasal approaches and some of the problems associated with accessing the deep structures and navigating major veins. Several specific anterior and posterior approaches are detailed, including their advantages and disadvantages, such as the risks of injuring veins, the fornix, hypothalamus, or causing visual loss.
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approaches to 3rd ventricle
- 1. Approaches to third ventricle Dr Raja shekhar
- 2. review
- 7. Common tumours Anterior 1/3 Posterior 1/3 Colloid cysts Pineal tumours Sellar mass meningioma aneurysm Arachnoid cyst meningioma Vein of galen malformation Sarcoidosis Hypothalamic glioma Optic glioma histiocytosis
- 8. Approaches broadly • Anterior • Lateral-includes into anterior • Posterior • transnasal PROBLEMS WITH APPROACH • Access , deep • Neural structures • Major veins along the way • Pituitary stalk • Fornix • Hypothalamus
- 10. approaches Anterior third Posterior third subfrontal Occipital transtentorial frontotemporal Supreacerebellar infratentorial Ant transcallosal interhemispheric Ant transcortical transsphenoidal
- 14. Anterior approach approach Advantage Disadvantage risk Interhemispheric transcallosal TF Utilizes natural opening ,sacrifice septal vein for widen access Limited working space Forniceal injury Transforaminal TC Extensive access to third ventricle Better Forniceal injury Deep veins damage (int cerebral veins) Transforaminal SC same Thalamostriate vein and superior choroidal vein injury Deep venous drainage (TS vein +sup choroidal +Int cere veins) IH TC Interforniceal same B/l fornix injury SUBFRONTAL-trans Lamina terminalis(reddish blush) Access to anteroinferior Better for prefixed chiasm Better for roof tumours Difficult subchiasmatic Limited view Close by neuro structures CSF leak Meningitis if frontal sinus violated TRANSFRONTAL WORKHORSE BLINDSPOTS-AntVentral chiasm recess/PostSuperioR Pineal
- 29. Posterior approach approach Advantage Disadvantage risk Occipital Tentorial Deep veins can be spared by pushing inferoposteriorly -can be used supra & infra tentorial -can be used for transsplenial & transfalcine -If veins move superiorly difficult surgical corridor -manipulate medial occipital cortex Major vein injury Galen, ROSENTHAL, Visual loss Infratentorial Supracerebellar Veinsspared by pushing to Ant superior Visual cortex spared Veins inferior difficult surgery Major vein damage IH Transcallosal Reduces manipulation of veins Limited exposure (focused only @ post 1/3) ICV , Straight sinus , Galen IH transsplenial For tumours immediately below splenium Only for subsplenial region Disconnection syndrome IH Retrocallosal Can b used for supraand infratentorial compartment tumours Around deep veins Medial occipital cortex Venous injury Visual loss