Endoscopic_Anatomy_of_the_Third_Ventricle-W.Seeger.pdf

Wolfgang Seeger

Endoscopic Anatomy of the Third Ventricle

Microsurgical and Endoscopic Approaches

In collaboration with

J. P. Warnke, St. Rosahl, and A. Weyerbrock

SpringerWienNewYork

Professor Dr. med. Wolfgang Seeger

Prof. em für Neurochirurgie der Universität Freiburg i. Br.

Au, Federal Republic of Germany

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ISBN-10 3-211-31177-7 SpringerWienNewYork

ISBN-13 978-3-211-31177-6 SpringerWienNewYork

Preface

Endoscopical surgery of the third ventricle has been applied for many years by transce-

rebral routes, especially as ventriculo-cisternostomies by opening the floor of the third

ventricle. These surgeries were carried out either free-hand, or using stereotaxy or – la-

ter on – neuronavigation. Spaceoccupying vascular and other lesions, such as tumors or

cysts located in the third ventricle, were usually eliminated by microsurgical approa-

ches. These approaches were carried out mainly by approaches along the extracerebral

midline structures or close to them. Midline approaches, especially approaches along

the falx crossing the Corpus callosum, are less invasive than transcerebral approaches.

Extracerebral midline approaches are variable in extent and direction of the approach,

transcerebral approaches are less variable. A further aspect is the sagittal extension of

the third ventricle in the midline so that it can be reached easily by midline surgical ap-

proaches. A combination of microsurgery (for the extraventricular part of surgery) and

endoscopy (for the intraventricular part of surgery) has been performed in the recent

years. However, the appliance of this combined technique is not common for the follow-

ing reasons:

– Rare indications for surgery of midline structures

– Technical aspects

Using flexible endoscopes it is possible to inspect all segments of the third ventricle.

But surgical manipulations are only possible in a straight direction. Flexible endosco-

pes are not available in all neurosurgical departments at this point of time.

– Anatomical aspects

– Anatomical details are well known for the microsurgical approaches. However, nume-

rous common variants of the anatomy of the extraventricular routes are still unknown.

In this book anatomical aspects important for combinations of microsurgical and endo-

scopical approaches are presented and illustrated. Numerous common anatomical va-

riants are demonstrated with reference to their impact for the surgical technique. Com-

binations of both surgical techniques are called “surgical” in this book, except for

procedures, which are exclusively microsurgical or endoscopical procedures. These

techniques are called “microsurgical”, or “endoscopical”, respectively.

The authors successor in Freiburg, Professor Dr. J. Zentner, made available rooms and

materials for the anatomical dissections and demonstrations, as he has been doing for

more than 7 years of his chairmanship in Freiburg. His vice-chairman Privatdozent Dr.

S. Rosahl, has demonstrated endoscopical and microsurgical operations during cadaver

head dissection.

The author found a good translator in Dr. A.Weyerbrock, who edited the manuscript and

helped to improve numerous neurosurgical aspects of presentation of this book.

I am grateful to Mrs. E. Rotermund, Professor Zentner’s secretary for typing and pre-

paring the final edition of the manuscript.

I would especially like to thank the Springer-Verlag Wien New York for the continuous

good cooperation, help and excellent production of this book.

Wolfgang Seeger

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