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ORIGINAL RESEARCH article

Front. Neuroanat.
Volume 19 - 2025 | doi: 10.3389/fnana.2025.1431128
This article is part of the Research Topic Microsurgical Anatomy of the Central Nervous System and Skull Base Volume II View all 6 articles

Optimal Trajectory of the Neuroendoscope for Third Ventricle Pavement Access

Provisionally accepted
Joana Sousa Joana Sousa 1Susana Maria Silva Susana Maria Silva 1*Hélio Alves Hélio Alves 1Bruno Carvalho Bruno Carvalho 1,2José Maria Sousa José Maria Sousa 2Manuel J Ferreira-Pinto Manuel J Ferreira-Pinto 1,2Jose Paulo Andrade Jose Paulo Andrade 1
  • 1 Faculty of Medicine, University of Porto, Porto, Portugal
  • 2 São João University Hospital Center, Porto, Porto, Portugal

The final, formatted version of the article will be published soon.

    Background & Aim: Endoscopic Third Ventriculostomy (ETV) is used to treat hydrocephalus, an abnormal cerebrospinal fluid accumulation in brain ventricles. By defining a new trajectory and entry point interval, we aim to establish a standardized approach for FreeHand ETV, a vital technique when specialized tools are unavailable, or during emergencies. Methods: 187 MRIs were analyzed, with 30 having hydrocephalus. A pathway crossing the cranial bone, interventricular foramen (of Monro) and tuber cinereum was outlined. Measurements involved distances to cranial sutures, pathway angles and depths, and distances to important anatomical landmarks. Comparisons between hydrocephalic and non-hydrocephalic patients were made while assessing variations linked to age, sex and Evan's index. Results: Significant differences were found, notably for depth (93.520 ± 7.228 mm), coronal plane angulation (10.982° ± 6.119°), distance to the sagittal suture (18.957 ± 8.608 mm), and distance to the superior frontal sulcus (7.00 mm). Other variables did not differ significantly between groups, including for the sagittal plane angulation (2.549° ± 3.576°) and the distances to the precentral sulcus (19.93 ± 7.955 mm), and to the coronal suture (10.55 mm). Conclusions: The new approach, situated close to cranial sutures and distant to the precentral and superior frontal sulcus, shows promise in enhancing surgical precision and outcomes for hydrocephalus management.

    Keywords: Third Ventricle, Neuroanatomy, endoscopic third ventriculostomy, Hydrocephalus, Neurosurgery

    Received: 11 May 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Sousa, Silva, Alves, Carvalho, Sousa, Ferreira-Pinto and Andrade. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Susana Maria Silva, Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.