Marking Basilar Artery Using Neuronavigation During Endoscopic Third Ventriculostomy: A Clinical Study.

Area of Science:

• Neurosurgery
• Medical Imaging
• Endoscopic Procedures

Background:

• Obstructive hydrocephalus requires surgical intervention like endoscopic third ventriculostomy (ETV).
• Accurate anatomical visualization is critical during ETV to avoid vascular injury, particularly to the basilar artery (BA).

Purpose of the Study:

• To assess the effectiveness of neuronavigation in delineating the relationship between the basilar artery (BA) and the ventricular floor during ETV.
• To evaluate the safety and utility of a neuronavigation-assisted approach for ETV.

Main Methods:

• Retrospective analysis of 28 patients (16 female, 12 male) with obstructive hydrocephalus undergoing neuroendoscopic procedures.
• Real-time visualization of the basilar artery (BA) using a neuronavigation system to assess its position relative to the third ventricle floor.
• Marking of the BA with neuronavigation in all cases.

Main Results:

• Successful ETV was achieved in all 28 patients.
• Neuronavigation marking of the BA prevented any intraoperative contact or related complications, such as major bleeding.
• Thickened tuber cinereum membrane (46.4%) and BA lateralization (10.7%) were noted in some patients, highlighting potential anatomical challenges.

Conclusions:

• Combining BA marking with neuronavigation offers enhanced safety for ETV procedures.
• This technique provides surgeons with clearer orientation, significantly reducing the risk of surgical morbidity.
• Neuronavigation is a valuable tool for improving precision and safety in ETV, especially in cases with challenging anatomy.