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

Emanuele La Corte, Adelina Selimi, Malte Ottenhausen, Jonathan A. Forbes, Mohamed M. Arnaout, Paolo Ferroli, Graziano Serrao, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalActa Neurochirurgica
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Third Ventricle
Feasibility Studies
Arteries
Dissection
Endoscopes
Optic Disk
Latex
Lenses
Ligation
Head

Keywords

  • Anterior communicating artery
  • Cadaver
  • Endonasal
  • Endoscopic
  • Lamina terminalis
  • Third ventricle

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle : an anatomical feasibility study. / La Corte, Emanuele; Selimi, Adelina; Ottenhausen, Malte; Forbes, Jonathan A.; Arnaout, Mohamed M.; Ferroli, Paolo; Serrao, Graziano; Anand, Vijay K.; Schwartz, Theodore H.

In: Acta Neurochirurgica, 01.01.2018.

Research output: Contribution to journalArticle

La Corte, Emanuele ; Selimi, Adelina ; Ottenhausen, Malte ; Forbes, Jonathan A. ; Arnaout, Mohamed M. ; Ferroli, Paolo ; Serrao, Graziano ; Anand, Vijay K. ; Schwartz, Theodore H. / Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle : an anatomical feasibility study. In: Acta Neurochirurgica. 2018.
@article{e1b6122809654ed58cd53ef4137bf70a,
title = "Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle: an anatomical feasibility study",
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.",
keywords = "Anterior communicating artery, Cadaver, Endonasal, Endoscopic, Lamina terminalis, Third ventricle",
author = "{La Corte}, Emanuele and Adelina Selimi and Malte Ottenhausen and Forbes, {Jonathan A.} and Arnaout, {Mohamed M.} and Paolo Ferroli and Graziano Serrao and Anand, {Vijay K.} and Schwartz, {Theodore H.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00701-018-3709-3",
language = "English",
journal = "Acta Neurochirurgica",
issn = "0001-6268",
publisher = "Springer Wien",

}

TY - JOUR

T1 - Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle

T2 - an anatomical feasibility study

AU - La Corte, Emanuele

AU - Selimi, Adelina

AU - Ottenhausen, Malte

AU - Forbes, Jonathan A.

AU - Arnaout, Mohamed M.

AU - Ferroli, Paolo

AU - Serrao, Graziano

AU - Anand, Vijay K.

AU - Schwartz, Theodore H.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Anterior communicating artery

KW - Cadaver

KW - Endonasal

KW - Endoscopic

KW - Lamina terminalis

KW - Third ventricle

UR - http://www.scopus.com/inward/record.url?scp=85056673312&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056673312&partnerID=8YFLogxK

U2 - 10.1007/s00701-018-3709-3

DO - 10.1007/s00701-018-3709-3

M3 - Article

AN - SCOPUS:85056673312

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

ER -