Morphometry of the anterior third ventricle region as a guide for the transcallosal-interforniceal approach

The transcallosal-interforniceal approach is the most appropriate approach to localize and totally remove space-occupying lesions around the anterior third ventricle region such as craniopharyngiomas and gliomas. This study examined the microsurgical anatomy of the normal anterior third ventricle region in 81 adult cadaver hemispheres. The central sulcus was identified and surface landmarks determined as the points 5 cm (P5) and 7 cm anterior to the central sulcus (P7). The distances between P5 and P7 and the upper margin of the interventricular foramen, which delineate the surgical corridor chosen to avoid disturbance of important neural structures, were 46.26-60.96 (54.09 +/- 3.35) mm and 48.00-62.00 (54.94 +/- 3.09) mm, respectively. The distances between the upper margin of the hemisphere and the cingulate sulcus, especially important for avoiding damage to the cingulate gyrus and other mesiolimbic structures, were 13.54-30.00 (21.28 +/- 3.89) mm and 12.22-29.52 (21.12 +/- 3.90) mm at the level of P5 and P7. The distances between the upper margin of the hemisphere and the callosal cistern containing the pericallosal artery were 28.34-40.50 (33.94 +/- 2.84) mm and 28.16-40.26 (33.50 +/- 2.61) mm, respectively. Normative morphometric data of the structures involved in the surgical procedure are necessary for planning and performance of the transcallosal-interforniceal approaches. This study of a large series of specimens shows that these measurements have large individual variations.