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Updated: May 7, 2026
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Endoscopic Third Ventriculostomy and Pineal Biopsy from a Single Entry Point
Published on: June 28, 2024
Third ventriculostomy site as a neuroreceptorial area
Luca Basaldella1, Alessandro Fiorindi, Francesco Sammartino
1Department of Neurosurgery, Treviso Regional Hospital, University of Padova, Pzza. le Ospedale Civile 1, 31100, Treviso, Italy, luca.basaldella@mac.com.
Summary
Fluorescein-guided endoscopic third ventriculostomy uses fluorescence to visualize the median eminence, helping surgeons spare this crucial structure during hydrocephalus treatment.
Area of Science:
- Neurosurgery
- Endoscopic Surgery
- Neuroanatomy
Background:
- Endoscopic third ventriculostomy (ETV) is a standard treatment for hydrocephalus.
- The floor of the third ventricle, particularly the median eminence, is vulnerable during ETV.
- Injury to the median eminence can have clinical consequences, but this is sparsely documented.
Purpose of the Study:
- To describe anatomical and operative findings during fluorescein-enhanced ETV.
- To evaluate the role of fluorescein visualization of the median eminence in preserving it during ETV.
Main Methods:
- Prospective study of 12 patients undergoing ETV.
- Intravenous fluorescein sodium (500 mg) administered prior to surgery.
- Flexible endoscope with dual white light and fluorescence modes used for visualization and guidance.
Main Results:
- Fluorescein enhanced visualization of the median eminence-tuber cinereum complex within 20 seconds.
- Preliminary results indicate that nearly half of the median eminence surface can be spared using fluorescence guidance.
- This technique aids in selecting the optimal stoma site and size.
Conclusions:
- Fluorescence-guided ETV is a feasible technique for preserving the median eminence.
- This approach may enhance the safety and improve outcomes of ETV.
- Tailoring ETV with fluorescence offers a potential method to mitigate iatrogenic injury to the median eminence.
