Mastering third ventricle surgery through anatomical laboratory knowledge

A thorough understanding of third ventricle anatomy is essential for safe and effective surgical planning, particularly for lesions in this deep and complex brain region. The ventricle is surrounded by critical neurovascular structures, whose variability can significantly influence the choice of surgical approach and the risk of complications. Anatomical knowledge, supported by cadaveric dissection and imaging, enables surgeons to anticipate challenges, minimize risks, and improve outcomes. This is especially important for third ventricular tumors, where errors may lead to neurological deficits due to injury of hypothalamic or vascular structures.

We present the case of a 19-year-old male presenting with clinical signs of hydrocephalus. Imaging revealed a tumor within the third ventricle. This video illustrates its surgical management, highlighting the importance of anatomical familiarity and proper approach selection. The approach was based on detailed anatomical insights, reinforced by cadaveric dissections. Anterior and inferior approaches to the subcallosal region carry a risk of damaging branches of the anterior cerebral artery (ACA), particularly the hypothalamic and subcallosal branches. Injury in these areas can result in memory deficits, amnestic-confabulatory syndrome, or hypothalamic dysfunction. To minimize these risks, we employed a bimanual interhemispheric transrostral approach. This technique provides controlled access to the floor of the third ventricle and hypothalamus through three anatomical windows. The integration of anatomical expertise, surgical strategy, and laboratory training is essential to achieve safe and effective outcomes in third ventricular surgery. The patient experienced no complications and showed progressive neurological recovery.

This case highlights the essential role of thorough third ventricle anatomical knowledge in planning safe and effective surgery. Laboratory-based training, including cadaveric dissections, allows surgeons to practice complex maneuvers, refine technical skills, and anticipate challenges before operating on patients. Combining deep anatomical understanding with hands-on practice is key to minimizing complications and achieving optimal outcomes in these high-risk procedures.