Surgery of the third ventricle

Cover......Page 1
Contents......Page 10
Part I. Historical perspective......Page 13
Cerebrospinal fluid and the ventricular system......Page 14
Lesion of the roof of the third ventricle......Page 21
Third ventricle tumors......Page 23
Operative approaches to the third ventricle......Page 39
References......Page 40
Part II. Fundamental consideration......Page 45
2. Comparative anatomy of the third ventricular region......Page 46
Lateral walls......Page 48
Floor......Page 52
Roof and posterior wall......Page 74
Commissures......Page 83
Arteries......Page 89
References......Page 98
Roof......Page 101
Anterior wall......Page 109
Lateral ventricle......Page 116
Anterior incisural space......Page 118
Middle incisural space......Page 122
Posterior Incisural space......Page 125
Internal carotid artery......Page 126
Ophtalmic artery......Page 127
Anterior cerebral and anterior communicating arteries......Page 128
Middle cerebral artery......Page 130
Posterior serebral artery......Page 131
Superior cerebellar artery......Page 132
Basal vein......Page 141
Ventricular drainage......Page 142
Incisural and cisternal veins......Page 144
Bringing veins......Page 148
Sphenoid bone......Page 161
Sphenoid sinus......Page 163
Pituitary gland......Page 164
Pituitary gland and carotid artery......Page 166
Cavernous sinus......Page 167
Discussion......Page 170
References......Page 174
Third ventricle and the pituitary region......Page 176
Pituitary adenomas......Page 177
Craniopharyngiomas......Page 178
Neuroepithelial (colloid) cyst of the third ventricle......Page 180
Pineal region tumors......Page 181
References......Page 182
Historically salient signs......Page 184
Acute disconnection syndrome (as observed in right-handers operated from the right side)......Page 185
Visual effects: double hemianopia......Page 189
Cross replication of hand postures......Page 190
Cross localization of finger tips......Page 191
Syndrome after corpus sallosotomy......Page 192
Syndrome after frontal comissurotomy......Page 193
Syndrome after callosotomy sparing the splenium......Page 194
Midcallosal section......Page 195
Posterior callosal (splenial) section......Page 196
Postcallosotomy mutism......Page 197
Concluding remarks......Page 199
References......Page 200
Amnesia associated with medial temporal and diencephalic damage......Page 204
Recent developments......Page 205
Anatomical underpinnings of memory......Page 207
References......Page 215
Hippocampal complex and lateral temporal lobe cortex......Page 218
References......Page 220
Anatomy and Chemistry of the hypothalamic region......Page 222
Functions of the hypothalamus......Page 224
Clinical disorders......Page 227
Conclusions......Page 229
References......Page 230
Anatomy of the deep venous system......Page 233
Angiographic patterns......Page 235
Disorders of the deep veonus system......Page 237
Surgical venous anatomy......Page 239
References......Page 241
Astrocytomas......Page 244
Glioblastoma multiforme......Page 246
Craniopharyngiomas and related cysts......Page 247
Colloid cysts......Page 249
Abscess......Page 250
Choroid plexus hemorrage and xanthoranulomas......Page 251
Lymphocytic hypophysitis......Page 252
Pituitary tumors and Rathke pouch lesions......Page 253
Teratomatous lesions including cysts......Page 254
Germinal tumors......Page 255
Neuroepithelial tumors......Page 257
References......Page 258
10. Tumor markers in third ventricular neoplasms......Page 262
Germ cell tumors......Page 263
Non-germ cerll tumors: pineal parenchymal tumors......Page 265
Other neuroectodermal tumors......Page 266
References......Page 269
Roof......Page 271
Anterior wall......Page 272
Floor......Page 273
Lateral walls......Page 274
Lesions along the roof of the third ventricle......Page 277
Lesions affecting the anterior wall of the thrid ventricle......Page 282
Lesions affecting the floor of the thrid ventricle......Page 285
Lesions affecting the posterior wall and pineal region......Page 293
Lesions affecting the lateral walls of the third ventricle......Page 297
Intraventricular lesions......Page 300
Appearence of lesions on MRI......Page 304
Referneces......Page 307
Prat III, Surgical approaches, techniques, and strategies......Page 310
History......Page 311
Surgical approaches......Page 312
Transcallosal-transventricular approach......Page 315
Transcortical-transventricular apporach......Page 327
Complication......Page 329
References......Page 332
Surgical technique......Page 334
Limbic system with special attention to structures involved in the third ventricular approach......Page 346
Medial temporal structures......Page 349
References......Page 358
Historical perspective......Page 362
Operative corridor: anatomy and physiological risks......Page 364
Structural......Page 366
Operative technique......Page 367
Complications......Page 385
Utilization......Page 386
References......Page 387
15. Subchoroidal trans-velum interpositum approach......Page 389
Indications......Page 390
Preoperative evaluation......Page 391
Technique......Page 394
References......Page 405
Surgical technique......Page 406
Problems and complications......Page 418
17. Bifrontal anterior interhemispheric approach......Page 421
Surgical technique......Page 425
Indications......Page 442
Summary......Page 445
References......Page 447
18. Pterional approach......Page 448
Indication for the pterional approach......Page 449
Preoperative evaluation......Page 451
Endocrinological testing......Page 453
Neuroradiological studies......Page 454
Technical aspects of the pterional approach to inferior third ventricular and parasellar lesions......Page 455
Pitfalls during the intraoperative period......Page 467
Complications......Page 468
References......Page 469
19. Combined approaches......Page 470
Technique......Page 472
Midline approach......Page 474
Dissection of the tumor at the foramina of Monro and in the third ventricle......Page 477
Pterional approach......Page 478
Summary......Page 480
Reference......Page 483
Historical perspective......Page 484
General guidelines......Page 485
Radiographic consideration......Page 486
Surgical procedures......Page 487
Pitfalls......Page 501
References......Page 502
Pathology: patterns of structural presentation......Page 503
Radiology: role of CT and MRI......Page 506
General technical prinsiples of transcranial approaches to the third ventricle......Page 508
Operative approaches......Page 510
Craniotomy......Page 511
Transcranial......Page 513
Cerebrospinal fluid diversion......Page 523
Memory......Page 524
Craniopharyngioma......Page 526
Colloid (neuroepithelial) cyst......Page 528
Radiology......Page 529
Management......Page 530
Selection of surgical procedure......Page 531
References......Page 543
Anatomical variants of craniopharingiomas......Page 551
Surgical technique......Page 552
Clinical considirations......Page 561
Anatomy of the third ventricle......Page 563
Specific nuclei......Page 564
Frontal approach......Page 565
References......Page 566
Preoperative evaluation and radiographic assessment......Page 567
Pictoral illustration of the technique......Page 568
Pitfalls during the intraoperative perios......Page 573
Complications associated with the technique......Page 574
References......Page 578
23. Infratentorial supracerebellar approach......Page 580
Advantages and contraindications......Page 583
Operative exposure and techniques......Page 584
Results......Page 599
References......Page 600
Advantages and indications......Page 601
Positioning of patient......Page 602
Instrumentation......Page 604
Operative technique......Page 605
Lesion management......Page 611
Intraoperative decisions......Page 616
Closure......Page 617
References......Page 619
Historical perspective......Page 621
Operative corridor: anatomy and physiological risks......Page 623
Spectrum of approach......Page 627
Structural definitions......Page 631
Operative technique......Page 632
Utilization......Page 649
References......Page 650
Commentary D. Operative management of malformations if the vein of Galen......Page 652
Clinical features and selection of management modes......Page 653
Operative approach......Page 655
References......Page 659
Controversies about the approaches......Page 660
The occipital supratentorial and transtentorial approach......Page 663
Strategies......Page 669
References......Page 673
So-called germ cell tumors and pineal tumor in the pineal-posterior third ventricular region......Page 674
Therapeutic principles and preoperative evaluation......Page 679
Historical perspectives of various approaches......Page 681
Indications for utilization of the various approaches......Page 682
Radotherapy or direct operation......Page 690
References......Page 692
Giant space-occupying lesions involving the anterior portion of the third ventricle......Page 695
Giant space-occupying lesions involving the lateral potion of the third ventricle......Page 701
Giant space-occupying lesions involving the posterior part of the third ventricle......Page 706
References......Page 708
Cerebrospinal fluid dynamics......Page 710
Ventriculostomy......Page 712
Intracranial CSF diversions......Page 716
Extracranial CSF diversion......Page 719
Utilization......Page 736
Optic nereve gliomas......Page 738
Craniopharyngiomas......Page 743
Pineal region tumors......Page 748
Thalamic tumors......Page 753
Hypothalamic tumors......Page 755
Suprasellar germinomas......Page 758
Subependymal mixed gliomas of tuberous sclerosis......Page 759
References......Page 760
31. Applications of computerized tomographic guidance stereotaxy......Page 762
Instrumentation and techniques......Page 763
Instrumentation at the target point......Page 769
Pathological considerations......Page 776
Interpretation of the stereotaxic biopsy......Page 777
Anesthetic considerations......Page 794
Experience and rationale for utilization of the technique......Page 795
References......Page 800
Commentary E. Contemporary european contributions to neurological stereotaxy......Page 804
Commentary F. Role of stereotaxis in the management of midline cerebral lesions......Page 814
Biopsy......Page 815
Craniopharyngiomas......Page 816
References......Page 817
Commentary G. Magnetic resonance stereotaxy......Page 818
Refereences......Page 822
Data base acquisition......Page 823
Surgical planning......Page 826
Discussion......Page 839
References......Page 840
Radiation tolerance of CNS......Page 841
Germ cell tumor......Page 842
Craniopharyngioma......Page 843
Stereotaxis radiosurgery......Page 844
Interstitial brachytherapy......Page 845
References......Page 846
Material and methods......Page 848
References......Page 852
Histological types of intracranial germ cell tumors......Page 853
Therapeutic modality and results......Page 854
References......Page 856