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Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle: an anatomical feasibility study

  • Original Article - Neurosurgical Anatomy
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Abstract

Background

Endonasal endoscopic approaches (EEA) to the third ventricle are well described but generally use an infrachiasmatic route since the suprachiasmatic translamina terminalis corridor is blocked by the anterior communicating artery (AComA). The bifrontal basal interhemispheric translamina terminalis approach has been facilitated with transection of the AComA. The aim of the study is to describe the anatomical feasibility and limitations of the EEA translamina terminalis approach to the third ventricle augmented with AComA surgical ligation.

Methods

Endoscopic dissections were performed on five cadaveric heads injected with colored latex using rod lens endoscopes attached to a high-definition camera and a digital video recorder system. A stepwise anatomical dissection of the endoscopic endonasal transtuberculum, transplanum, translamina terminalis approach to the third ventricle was performed. Measurements were performed before and after AComA elevation and transection using a millimeter flexible caliper.

Results

Multiple comparison statistical analysis revealed a statistically significant difference in vertical exposure between the control condition and after AComA elevation, between the control condition and after AComA division and between the AComA elevation and division (p < 0.05). The mean difference in exposed surgical area was statistically significant between the control and after AComA division and between elevation and AComA division (p < 0.01), whereas it was not statistically significant between the control condition and AComA elevation (NS).

Conclusion

The anatomical feasibility of clipping and dividing the AComA through an EEA has been demonstrated in all the cadaveric specimens. The approach facilitates exposure of the suprachiasmatic optic recess within the third ventricle that may be a blind spot during an infrachiasmatic approach.

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Abbreviations

ACA:

Anterior cerebral artery

AComA:

Anterior communicating artery

EEA:

Extended endonasal approach

GTR:

Gross-total resection

ICA:

Internal carotid artery

ICG:

Indocyanine green

LT:

Lamina terminalis

TCA:

Transcranial approach

TV:

Third ventricle

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Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Emanuele La Corte, Adelina Selimi, Malte Ottenhausen, Jonathan A. Forbes, Mohamed M. Arnaout & Theodore H. Schwartz

  2. Department of Health Sciences, University of Milan, Milan, Italy

    Emanuele La Corte & Graziano Serrao

  3. Department of Neurosurgery, Foundation IRCCS Neurological Institute “Carlo Besta”, Milan, Italy

    Emanuele La Corte & Paolo Ferroli

  4. Department of Medicine, University of Perugia, Perugia, Italy

    Adelina Selimi

  5. Department of Neurosurgery, University Mainz, Mainz, Germany

    Malte Ottenhausen

  6. Department of Neurosurgery, Zagazig University, Zagazig, Egypt

    Mohamed M. Arnaout

  7. Department of Neuroscience, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Vijay K. Anand & Theodore H. Schwartz

  8. Department of Otolaryngology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

Authors
  1. Emanuele La Corte
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  2. Adelina Selimi
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Correspondence to Theodore H. Schwartz.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB was not required since the study involved only cadaveric specimens.

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This article is part of the Topical Collection on Neurosurgical Anatomy

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La Corte, E., Selimi, A., Ottenhausen, M. et al. Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle: an anatomical feasibility study. Acta Neurochir 161, 811–820 (2019). https://doi.org/10.1007/s00701-018-3709-3

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  • DOI: https://doi.org/10.1007/s00701-018-3709-3

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