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Published on: May 19, 2015
The vascular safe zone for endoscopic third ventriculostomy: a radiomorphometric study
Nicolás Rincón-Arias1, Nadin J Abdala-Vargas2, Sabino Luzzi3
1Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud - FUCS, Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud - FUCS, Hospital Infantil Universitario de San José, Bogotá, Colombia.
This study identifies the safest area for endoscopic third ventriculostomy (ETV) fenestration by analyzing neuroanatomy. The anterior floor of the third ventricle is the recommended "vascular safe zone" to avoid basilar artery injury.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neuroanatomy
Background:
- Endoscopic third ventriculostomy (ETV) is a key procedure for hydrocephalus.
- The floor of the third ventricle (3VF) and basilar artery (BA) complex anatomy influence ETV risks.
- Identifying a
- vascular safe zone
- is crucial for ETV safety.
Purpose of the Study:
- To evaluate the neuroradiological characteristics of the 3VF and BA complex.
- To define the optimal ETV fenestration
- vascular safe zone
- to minimize BA complex injury.
Main Methods:
- Retrospective review of preoperative MRI scans from adult ETV patients (Jan 2016 - Mar 2025).
- Analysis of sagittal and axial 3VF and BA complex neuroradiological features.
Main Results:
- The basilar artery (BA) complex was predominantly in the posterior half of the 3VF (71.2%).
- Type II anatomy was most common in the sagittal plane (74%).
- Specific distances from the BA complex to the 3VF were quantified in sagittal and axial planes.
Conclusions:
- The anterior half of the 3VF is suggested as the primary
- vascular safe zone
- for ETV fenestration.
- Further research with intraoperative neuroendoscopy is needed to validate this zone.
- Clinical outcomes should be assessed to confirm the effectiveness of the proposed fenestration area.
