E-ISSN: 1019-5157
ISSN: 2651-5024
Research
ANATOMICAL FRAMEWORK OF THE ENDOSCOPIC TRANSSPHENOIDAL APPROACH TO THE THIRD VENTRICLE
Hasan Çağrı Postuk✉ ,
Muhammet Enes Gürses ,
Aysu İyigün Kabakcı ,
Ebubekir Akpınar ,
Ali Rıza Güvercin ,
Erhan Arslan ,
Cumhur Kaan Yaltırık ,
Mehmet Hakan Şahin ,
Savaş Ceylan ,
Abuzer Güngör
DOI: 10.5137/1019-5149.JTN.49308-25.2
Article in Press
Corresponding Author:
Hasan Çağrı Postuk (cagripostuk@gmail.com)
Abstract
Aim
Surgical access to the third ventricle is particularly challenging because of its deep location and close relationship with critical neurovascular structures. The endoscopic transsphenoidal (ETS) approach provides access deeply situated structures such as the third ventricle while minimizing disruption to adjacent vascular and neural tissues.
Material and Methods
The ETS approach to the third ventricle can be performed through two routes: the suprachiasmatic and infrachiasmatic routes. However, anatomical data regarding these approaches remain limited in the literature. This study aimed to demonstrate the anatomical basis of the ETS approach to the third ventricle.
Results
Dissections were conducted on five formalin-fixed cadaveric specimens injected with silicone dye, using both microscopic and endoscopic techniques. Microscopic dissections were performed through the right nostril and focused on key anatomical landmarks, including the sellar base, planum sphenoidale, clivus, and bilateral carotid and optic prominences. Subsequently, the endoscopic stage was performed 0° and 30° telescopes. The ETS approach to the third ventricle was evaluated in four stages: nasal, sphenoidal, sellar, and third ventricular. The sellar and third ventricular stages were further assessed according to the chosen route, either suprachiasmatic or infrachiasmatic.
Conclusion
Our cadaveric study demonstrated that the third ventricle can be accessed via the ETS approach using either the suprachiasmatic or infrachiasmatic route, offering a broad visualization of neurovascular structures, including the interthalamic adhesion, foramen of Monro, choroid plexus, posterior commissure, habenular commissure, stria medullaris thalami, tela choroidea, and pineal gland. With ongoing technological advancements and increasing surgical expertise in endoscopic techniques, the ETS approach through the nasal cavity may be a promising alternative for accessing deep-seated structures such as the third ventricle in the future.
Surgical access to the third ventricle is particularly challenging because of its deep location and close relationship with critical neurovascular structures. The endoscopic transsphenoidal (ETS) approach provides access deeply situated structures such as the third ventricle while minimizing disruption to adjacent vascular and neural tissues.
Material and Methods
The ETS approach to the third ventricle can be performed through two routes: the suprachiasmatic and infrachiasmatic routes. However, anatomical data regarding these approaches remain limited in the literature. This study aimed to demonstrate the anatomical basis of the ETS approach to the third ventricle.
Results
Dissections were conducted on five formalin-fixed cadaveric specimens injected with silicone dye, using both microscopic and endoscopic techniques. Microscopic dissections were performed through the right nostril and focused on key anatomical landmarks, including the sellar base, planum sphenoidale, clivus, and bilateral carotid and optic prominences. Subsequently, the endoscopic stage was performed 0° and 30° telescopes. The ETS approach to the third ventricle was evaluated in four stages: nasal, sphenoidal, sellar, and third ventricular. The sellar and third ventricular stages were further assessed according to the chosen route, either suprachiasmatic or infrachiasmatic.
Conclusion
Our cadaveric study demonstrated that the third ventricle can be accessed via the ETS approach using either the suprachiasmatic or infrachiasmatic route, offering a broad visualization of neurovascular structures, including the interthalamic adhesion, foramen of Monro, choroid plexus, posterior commissure, habenular commissure, stria medullaris thalami, tela choroidea, and pineal gland. With ongoing technological advancements and increasing surgical expertise in endoscopic techniques, the ETS approach through the nasal cavity may be a promising alternative for accessing deep-seated structures such as the third ventricle in the future.
Keywords
endoscopic transsphenoidal approach
third ventricle
skull base
suprachiasmatic
infrachiasmatic