Skip to main content
SpringerLink
Log in

Surgical Technique of Endoscopic Third Ventriculostomy (ETV)

  • Chapter
  • First Online:
Endoscopic Third Ventriculostomy

Abstract

The ventricular access point to the ETV is Kocher’s point, which is located approximately 2 cm lateral to the midline and 2 cm anterior to the coronal suture. The exact site for fenestration is preferably at the midpoint between the mammillary bodies and the infundibular recess. Just below third ventricle floor is located the membrane of Liliequist. The membrane is divided into two portions: the upper one (diencephalic), which is inserted anteriorly to the mammillary bodies, and the inferior one (mesencephalic), which extends to the mesencephalic-pons groove. During ETV to fenestrate mesencephalic portion is mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dezena RA. Atlas of endoscopic neurosurgery of the third ventricle. In: Basic principles for ventricular approaches and essential intraoperative anatomy. 1th ed. Cham: Springer International Publishing AG; 2017. https://doi.org/10.1007/978-3-319-50068-3-1.

    Chapter  Google Scholar 

  2. Devaux BC, Joly LM, Page P, Nataf F, Turak B, Beuvon F, et al. Laser-assisted endoscopic third ventriculostomy for obstructive hydrocephalus: technique and results in a series of 40 consecutive cases. Lasers Surg Med. 2004;34(5):368–78.

    Article  Google Scholar 

  3. Deopujari CE, Karmarkar VS, Shaikh ST. Endoscopic third ventriculostomy: success and failure. J Korean Neurosurg Soc. 2017;60(3):306–14. https://doi.org/10.3340/jkns.2017.0202.013.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vogel TW, Bahuleyan B, Robinson S, Cohen AR. The role of endoscopic third ventriculostomy in the treatment of hydrocephalus. J Neurosurg Pediatr. 2013;12(1):54–61. https://doi.org/10.3171/2013.4.PEDS12481.

    Article  PubMed  Google Scholar 

  5. Tubbs RS, Hattab EM, Loukas M, Chern JJ, Wellons M, Wellons JC III, et al. Histological analysis of the third ventricle floor in hydrocephalic and nonhydrocephalic brains: application to neuroendocrine complications following third ventriculostomy procedures. J Neurosurg Pediatr. 2012;9(2):178–81. https://doi.org/10.3171/2011.11.PEDS11290.

    Article  PubMed  Google Scholar 

  6. Seeger W, Zentner J. Anatomical basis of cranial neurosurgery. 1th ed. Cham: Springer International Publishing AG; 2018. https://doi.org/10.1007/978-3-319-63597-2.

    Book  Google Scholar 

  7. Seeger W. Endoscopic and microsurgical anatomy of the upper basal cisterns. Wien: Springer; 2008. https://doi.org/10.1007/978-3-211-77035-1.

    Book  Google Scholar 

  8. Connor DE Jr, Nanda A. Bengt Liliequist: life and accomplishments of a true renaissance man. J Neurosurg. 2016;126(2):1–5.

    Google Scholar 

  9. Key A, Retzius MG. Studien in der Anatomie des Nervensystems und des Bindegewebes. Stockholm: Samson and Wallin; 1875.

    Google Scholar 

  10. Yasargil MG, Kasdaglis K, Jain KK, Weber HP. Anatomical observations of the subarachnoid cisterns of the brain during surgery. J Neurosurg. 1976;44(3):298–302.

    Article  CAS  Google Scholar 

  11. Vinas FC, Panigrahi M. Microsurgical anatomy of the Liliequist’s membrane and surrounding neurovascular territories. Minim Invasive Neurosurg. 2001;44(2):104–9.

    Article  CAS  Google Scholar 

  12. Lü J, Zhu X. Microsurgical anatomy of the interpeduncular cistern and related arachnoid membranes. J Neurosurg. 2005;103(2):337–41.

    Article  Google Scholar 

  13. Sufianov AA, Sufianova GZ, Iakimov IA. Microsurgical study of the interpeduncular cistern and its communication with adjoining cisterns. Childs Nerv Syst. 2009;25(3):301–8. https://doi.org/10.1007/s00381-008-0746-x.

    Article  PubMed  Google Scholar 

  14. Qi ST, Fan J, Zhang XA, Pan J. Reinvestigation of the ambient cistern and its related arachnoid membranes: an anatomical study. J Neurosurg. 2011;115(1):171–8. https://doi.org/10.3171/2011.2.JNS101365.

    Article  PubMed  Google Scholar 

  15. Wang SS, Zheng HP, Zhang FH, Wang RM. Microsurgical anatomy of Liliequist’s membrane demonstrating three-dimensional configuration. Acta Neurochir. 2011;153(1):191–200. https://doi.org/10.1007/s00701-010-0823-2.

    Article  PubMed  Google Scholar 

  16. Buxton N, Vloeberghs M, Punt J. Liliequist’s membrane in minimally invasive endoscopic neurosurgery. Clin Anat. 1998;11(3):187–90.

    Article  CAS  Google Scholar 

  17. Froelich SC, Abdel Aziz KM, Cohen PD, van Loveren HR, Keller JT. Microsurgical and endoscopic anatomy of Liliequist’s membrane: a complex and variable structure of the basal cisterns. Neurosurgery. 2008;63(1 Suppl 1):ONS1–8; discussion ONS8-9. https://doi.org/10.1227/01.neu.0000335004.22628.

    Article  PubMed  Google Scholar 

  18. Inoue K, Seker A, Osawa S, Alencastro LF, Matsushima T, Rhoton AL Jr. Microsurgical and endoscopic anatomy of the supratentorial arachnoidal membranes and cisterns. Neurosurgery. 2009;65(4):644–64; discussion 665. https://doi.org/10.1227/01.NEU.0000351774.81674.32.

    Article  PubMed  Google Scholar 

  19. Anik I, Ceylan S, Koc K, Tugasaygi M, Sirin G, Gazioglu N, et al. Microsurgical and endoscopic anatomy of Liliequist’s membrane and the prepontine membranes: cadaveric study and clinical implications. Acta Neurochir. 2011;153(8):1701–11. https://doi.org/10.1007/s00701-011-0978-5.

    Article  PubMed  Google Scholar 

  20. Zhang XA, Qi ST, Huang GL, Long H, Fan J, Peng JX. Anatomical and histological study of Liliequist’s membrane: with emphasis on its nature and lateral attachments. Childs Nerv Syst. 2012;28(1):65–72. https://doi.org/10.1007/s00381-011-1599-2.

    Article  PubMed  Google Scholar 

  21. Dezena R. Endoscopic views of the membrane of Liliequist. J Bras Neurocirurg. 2015;26(4):320–3.

    Google Scholar 

  22. Fushimi Y, Miki Y, Ueba T, Kanagaki M, Takahashi T, Yamamoto A, et al. Liliequist membrane: three-dimensional constructive interference in steady state MR imaging. Radiology. 2003;229(2):360–5; discussion 365.

    Article  Google Scholar 

  23. Anik I, Ceylan S, Koc K, Anık Y, Etus V, Genc H. Role of interpeduncular and prepontine cistern cerebrospinal fluid flow measurements in prediction of endoscopic third ventriculostomy success in pediatric triventricular hydrocephalus. Pediatr Neurosurg. 2010;46(5):344–50. https://doi.org/10.1159/000323413.

    Article  PubMed  Google Scholar 

  24. Anik I, Ceylan S, Koc K, Anık Y, Etus V, Genc H. Membranous structures affecting the success of endoscopic third ventriculostomy in adult aqueductus sylvii stenosis. Minim Invasive Neurosurg. 2011;54(2):68–74. https://doi.org/10.1055/s-0031-1277172.

    Article  CAS  PubMed  Google Scholar 

  25. Etus V, Solakoglu S, Ceylan S. Ultrastructural changes in the Liliequist membrane in the hydrocephalic process and its implications for the endoscopic third ventriculostomy procedure. Turkish Neurosurg. 2011;21(3):359–66. https://doi.org/10.5137/1019-5149.JTN.4171-11.0.

    Article  Google Scholar 

  26. Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract. 2012;3(2):163–73. https://doi.org/10.4103/0976-3147.98222.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Romero L, Ros B, Ibáñez G, Ríus F, González L, Arráez M. Endoscopic third ventriculostomy: can we predict success during surgery? Neurosurg Rev. 2014;37(1):89–97. https://doi.org/10.1007/s10143-013-0494-6.

    Article  CAS  PubMed  Google Scholar 

  28. Mortazavi MM, Rizq F, Harmon O, Adeeb N, Gorjian M, Hose N, et al. Anatomical variations and neurosurgical significance of Liliequist’s membrane. Childs Nerv Syst. 2015;31(1):15–28. https://doi.org/10.1007/s00381-014-2590-5.

    Article  PubMed  Google Scholar 

  29. Schulte-Altedorneburg G, Linn J, Kunz M, Brückmann H, Zausinger S, Morhard D. Visualization of Liliequist’s membrane prior to endoscopic third ventriculostomy. Radiol Med. 2016;121(3):200–5. https://doi.org/10.1007/s11547-015-0588-z.

    Article  PubMed  Google Scholar 

  30. Dezena RA. Inside the third ventricle. In: Atlas of endoscopic neurosurgery of the third ventricle. Cham: Springer; 2017. p. 121–208.

    Chapter  Google Scholar 

  31. Seeger W, Zentner J. Anatomical base of surgery. In: Anatomical basis of cranial neurosurgery. Cham: Springer; 2018. p. 19–74.

    Chapter  Google Scholar 

  32. Seeger W. Topography of basal cisterns (figs. 14 to 30). In: Endoscopic and microsurgical anatomy of the upper basal cisterns. Vienna: Springer; 2008. p. 5–8.

    Google Scholar 

  33. Dezena RA. Beyond the third ventricle: inside the interpeduncular and prepontine cisterns. In: Atlas of endoscopic neurosurgery of the third ventricle. Cham: Springer; 2017. p. 209–36. With permission from Springer Nature.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil

    Roberto Alexandre Dezena

Authors
  1. Roberto Alexandre Dezena
    View author publications

    You can also search for this author in PubMed Google Scholar

1 Electronic Supplementary Material

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Bipolar coagulation of tuber cinereum reaching membrane of Liliequist opening also. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of basilar artery, pontine branches, and right vertebral artery together with posterior inferior cerebellar artery from it (AVI 218661 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Bipolar coagulation of tuber cinereum, not reaching membrane of Liliequist opening. Fenestration of this membrane and ostomy enlargement by Fogarty balloon catheter. At the end, visualization of dorsum sellae, sella turcica, and basilar artery (AVI 214207 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro and visualization of interthalamic adhesion and cerebral aqueduct just after to enter inside it. Bipolar coagulation of a dark tuber cinereum reaching membrane of Liliequist opening also. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of basilar artery, pontine branches, and mesencephalic portion of membrane of Liliequist (AVI 224522 kb)

Standard ETV. Visualization of optic chiasm just in front of infundibulum. Bipolar coagulation of tuber cinereum reaching membrane of Liliequist opening also. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of basilar artery, pontine branches, and dorsum sellae (AVI 122665 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro and visualization of fórnix column. Bipolar coagulation of tuber cinereum reaching membrane of Liliequist opening also. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of basilar artery, pontine branches, and dorsum sellae (AVI 184435 kb)

Standard ETV. Bipolar coagulation of tuber cinereum laterally to basilar artery in front right mammillary body, reaching membrane of Liliequist opening also. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of right superior cerebellar artery and right posterior cerebral artery, both from basilar arteries (AVI 225225 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Fenestration of tuber cinereum reaching membrane of Liliequist opening also by nonactivated bipolar coagulator. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of basilar artery and pontine branches right vertebral artery and foramen magnum (AVI 240697 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Visualization of clots inside the third ventricle. Fenestration of tuber cinereum by nonactivated bipolar coagulator, not reaching membrane of Liliequist opening. Fenestration of this membrane and ostomy enlargement by Fogarty balloon catheter. At the end, visualization of diencephalic portion of membrane of Liliequist partially opened (AVI 220185 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Visualization of interthalamic adhesion just after to enter inside third ventricle. Fenestration of tuber cinereum reaching membrane of Liliequist opening also by nonactivated bipolar coagulator. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of thalamoperforating arteries from left posterior cerebral artery (AVI 198383 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Visualization of basilar artery, posterior cerebral arteries, and posterior communicating arteries, just below a delicate tuber cinereum. Fenestration of tuber cinereum reaching membrane of Liliequist opening also by nonactivated bipolar coagulator. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of right posterior communicating artery and basilar artery and its branches (AVI 220888 kb)

Standard ETV. Just after inside of the third ventricle visualization of cerebral aqueduct entrance. Visualization of a ballooned and delicate tuber cinereum. Fenestration of tuber cinereum reaching membrane of Liliequist opening also by nonactivated bipolar coagulator. Ostomy enlargement by Fogarty balloon catheter. At the end, visualization of a CSF flow through ostomy (AVI 178692 kb)

Standard ETV. Entrance inside third ventricle through right foramen of Monro. Visualization of interthalamic adhesion just after to enter inside third ventricle. Visualization of a membrane from interthalamic adhesion over mammillary bodies. Fenestration of tuber cinereum by nonactivated bipolar coagulator lateral to basilar artery, not reaching membrane of Liliequist opening. Fenestration of this membrane by nonactivated bipolar coagulator also and ostomy enlargement by Fogarty balloon catheter. At the end, visualization of fenestrated diencephalic portion of membrane of Liliequist and basilar artery pontine branches (AVI 244096 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dezena, R.A. (2020). Surgical Technique of Endoscopic Third Ventriculostomy (ETV). In: Endoscopic Third Ventriculostomy. Springer, Cham. https://doi.org/10.1007/978-3-030-28657-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-28657-6_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28656-9

  • Online ISBN: 978-3-030-28657-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation