Full-Endoscopic Minimally-Invasive Trans-Magendie Approach to the Fourth Ventricle: An Anatomical Feasibility Study.

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Endoscopic Techniques

Background:

• The telovelar approach accesses the fourth ventricle but has limitations in visualizing the aqueduct.
• Traditional methods often require C1 posterior arch resection for better access.
• Endoscopic techniques aim to overcome these limitations for improved surgical access.

Purpose of the Study:

• To describe and evaluate a full-endoscopic, retractorless, trans-Magendie approach.
• To access the inferior third of the fourth ventricle without C1 posterior arch resection.
• To assess the feasibility of a minimally invasive burr-hole suboccipital craniotomy.

Main Methods:

• Investigation of four formalin-fixed, injected cadaveric heads.
• Step-by-step anatomical description of the endoscopic trans-Magendie approach.
• Evaluation of visualization and feasibility without C1 laminectomy.

Main Results:

• The endoscopic approach achieved adequate cranial and lateral visualization of the aqueduct and fourth ventricle floor.
• Successful visualization was accomplished without the need for C1 posterior arch resection.
• The approach provided clear views of critical structures within the fourth ventricle.

Conclusions:

• The full-endoscopic trans-Magendie approach effectively visualizes the inferior fourth ventricle and caudal aqueduct.
• This technique avoids the necessity of a C1 laminectomy.
• It offers a minimally invasive alternative with reduced craniotomy size.