Acta Neurochirurgica

, Volume 159, Issue 4, pp 645–654

Supraorbital subfrontal trans-laminar endoscope-assisted approach for tumors of the posterior third ventricle

  • Maurizio Iacoangeli
  • Roberto Colasanti
  • Domenic Esposito
  • Alessandro Di Rienzo
  • Lucia di Somma
  • Mauro Dobran
  • Maurizio Gladi
  • Massimo Scerrati
Original Article _ Brain Tumors

DOI: 10.1007/s00701-017-3117-0

Cite this article as:
Iacoangeli, M., Colasanti, R., Esposito, D. et al. Acta Neurochir (2017) 159: 645. doi:10.1007/s00701-017-3117-0



Different surgical approaches have been developed for dealing with third ventricle lesions, all aimed at obtaining a safe removal minimizing brain manipulation. The supraorbital subfrontal trans-lamina terminalis route, commonly employed only for the anterior third ventricle, could represent, in selected cases with endoscopic assistance, an alternative approach to posterior third ventricular lesions.


Seven patients underwent a supraorbital subfrontal trans-laminar endoscope-assisted approach to posterior third ventricle tumors (two craniopharyngiomas, one papillary tumor of the pineal region, one pineocytoma, two neurocytomas, one glioblastoma). Moreover, a conventional third ventriculostomy was performed via the same trans-laminar approach in four cases.


Complete tumor removal was accomplished in four cases, subtotal removal in two cases, and a simple biopsy in one case. Adjuvant radiotherapy and/or chemotherapy was administered, if required, on the basis of the histologic diagnosis. No major complications occurred after surgery except for an intratumoral hemorrhage in a patient undergoing a biopsy for a glioblastoma, which simply delayed the beginning of adjuvant radiochemotherapy. No ventriculoperitoneal shunt placement was needed in these patients at the most recent clinical and radiologic session (average 39.57 months, range 13–85 months). Two illustrative cases are presented.


The supraorbital subfrontal trans-laminar endoscope-assisted approach may provide, in selected cases, an efficient and safe route for dealing with posterior third ventricular tumors.


Endoscopic assistance Key-hole approach Minimally invasive surgery Posterior third ventricle tumor Supraorbital subfrontal approach Trans-lamina terminalis 

Supplementary material

701_2017_3117_MOESM1_ESM.wmv (33.3 mb)
Supplemental Digital ContentVideo illustrating the removal of a posterior third ventricle lesion by the supraorbital subfrontal trans-laminar endoscope-assisted approach. (WMV 34095 kb)

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.Department of Neurosurgery, Umberto I General HospitalUniversità Politecnica delle MarcheAnconaItaly

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