Acta Neurochirurgica

, Volume 159, Issue 4, pp 645–654 | Cite as

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



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)


  1. 1.
    Abdou MS, Cohen AR (2000) Endoscopic surgery of the third ventricle: the subfrontal trans-lamina terminalis approach. Minim Invasive Neurosurg 43(4):208–211CrossRefPubMedGoogle Scholar
  2. 2.
    Cavallo LM, Solari D, Esposito F, Villa A, Minniti G, Cappabianca P (2014) The role of the endoscopic endonasal route in the management of craniopharyngiomas. World Neurosurg 82(6 Suppl):S32–S40CrossRefPubMedGoogle Scholar
  3. 3.
    Cavallo LM, Solari D, Esposito F, Cappabianca P (2013) The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle. Neurosurg Rev 36(1):27–37, discussion 38CrossRefPubMedGoogle Scholar
  4. 4.
    Charalampaki P, Filippi R, Welschehold S, Conrad J, Perneczky A (2008) Tumors of the lateral and third ventricle: removal under endoscope-assisted keyhole conditions. Neurosurgery 62(6 Suppl 3):1049–1058PubMedGoogle Scholar
  5. 5.
    Chibbaro S, Di Rocco F, Makiese O et al (2012) Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 35(3):331-338-340Google Scholar
  6. 6.
    Colasanti R, Lamki T, Tailor A-RA, Ammirati M (2014) Recurrent atlantoaxial synovial cyst resection via a navigation-guided, endoscope-assisted posterior approach. Surg Neurol Int 5(Suppl 15):S567–S569PubMedPubMedCentralGoogle Scholar
  7. 7.
    Colasanti R, Tailor A-RA, Gorjian M, Zhang J, Ammirati M (2015) Microsurgical and endoscopic anatomy of the extended retrosigmoid inframeatal infratemporal approach. Neurosurgery 11(Suppl 2):181–189, discussion 189PubMedGoogle Scholar
  8. 8.
    Colasanti R, Tailor A-RA, Lamki T, Zhang J, Ammirati M (2015) Maximizing the petroclival region exposure via a suboccipital retrosigmoid approach: where is the intrapetrous internal carotid artery? Neurosurgery 11(Suppl 2):329-336-337Google Scholar
  9. 9.
    Colasanti R, Tailor A-RA, Zhang J, Ammirati M (2016) Expanding the horizon of the suboccipital retrosigmoid approach to the middle incisural space by cutting the tentorium cerebelli: anatomic study and illustration of 2 cases. World Neurosurg 92:303–312CrossRefPubMedGoogle Scholar
  10. 10.
    Colasanti R, Tailor A-RA, Zhang J, Ammirati M (2016) Functional petrosectomy via a suboccipital retrosigmoid approach: guidelines and topography. World Neurosurg 87:143–154CrossRefPubMedGoogle Scholar
  11. 11.
    Dandy WE (1921) An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:113–119Google Scholar
  12. 12.
    Dandy WE (1933) Benign tumors in the third ventricle of the brain: diagnosis and treatment. Charles C Thomas, SpringfieldGoogle Scholar
  13. 13.
    de Divitiis O, Angileri FF, d’Avella D, Tschabitscher M, Tomasello F (2002) Microsurgical anatomic features of the lamina terminalis. Neurosurgery 50(3):563-569-570Google Scholar
  14. 14.
    Dehdashti AR, de Tribolet N (2008) Frontobasal interhemispheric trans-lamina terminalis approach for suprasellar lesions. Neurosurgery 62(6 Suppl 3):1233–1239PubMedGoogle Scholar
  15. 15.
    Figueiredo EG, Deshmukh V, Nakaji P, Deshmukh P, Crusius MU, Crawford N, Spetzler RF, Preul MC (2006) An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 59(4 Suppl 2):ONS212-220; discussion ONS220Google Scholar
  16. 16.
    Iacoangeli M, Di Rienzo A, Colasanti R, et al. Endoscopic transnasal odontoidectomy with anterior C1 arch preservation and anterior vertebral column reconstruction in patients with irreducible bulbomedullary compression by complex craniovertebral junction abnormalities: operative nuance. Neurosurgery. doi:10.1227/NEU.0000000000001330
  17. 17.
    Iacoangeli M, Di Rienzo A, di Somma LGM, Moriconi E, Alvaro L, Re M, Salvinelli F, Carassiti M, Scerrati M (2014) Improving the endoscopic endonasal transclival approach: the importance of a precise layer by layer reconstruction. Br J Neurosurg 28(2):241–246CrossRefPubMedGoogle Scholar
  18. 18.
    Iacoangeli M, Di Rienzo A, Nocchi N, Balercia P, Lupi E, Regnicolo L, Di Somma LGM, Alvaro L, Scerrati M (2015) Piezosurgery as a further technical adjunct in minimally invasive supraorbital keyhole approach and lateral orbitotomy. J Neurol Surg A Cent Eur Neurosurg 76(2):112–118PubMedGoogle Scholar
  19. 19.
    Iacoangeli M, Di Rienzo A, Re M, Alvaro L, Nocchi N, Gladi M, De Nicola M, Scerrati M (2013) Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture. Cancer Manag Res 5:21–24CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Iacoangeli M, Neri P, Balercia P, Lupi E, Di Rienzo A, Nocchi N, Alvaro L, Scerrati M (2013) Piezosurgery for osteotomies in orbital surgery: our experience and review of the literature. Int J Surg Case Rep 4(2):188–191CrossRefPubMedGoogle Scholar
  21. 21.
    Iacoangeli M, Nocchi N, Nasi D, DI Rienzo A, Dobran M, Gladi M, Colasanti R, Alvaro L, Polonara G, Scerrati M (2016) Minimally invasive supraorbital key-hole approach for the treatment of anterior cranial fossa meningiomas. Neurol Med Chir (Tokyo) 56(4):180–185CrossRefGoogle Scholar
  22. 22.
    Iacoangeli M, Rienzo AD, Colasanti R, Scarpelli M, Gladi M, Alvaro L, Nocchi N, Scerrati M (2014) A rare case of chordoma and craniopharyngioma treated by an endoscopic endonasal, transtubercular transclival approach. Turk Neurosurg 24(1):86–89PubMedGoogle Scholar
  23. 23.
    King TT (1979) Removal of intraventricular craniopharyngiomas through the lamina terminalis. Acta Neurochir (Wien) 45(3–4):277–286CrossRefGoogle Scholar
  24. 24.
    Krishna V, Blaker B, Kosnik L, Patel S, Vandergrift W (2011) Trans-lamina terminalis approach to third ventricle using supraorbital craniotomy: technique description and literature review for outcome comparison with anterior, lateral and trans-sphenoidal corridors. Minim Invasive Neurosurg 54(5–6):236–242PubMedGoogle Scholar
  25. 25.
    Lan Q, Dong J, Huang Q (2006) Minimally invasive keyhole approaches for removal of tumors of the third ventricle. Chin Med J (Engl) 119(17):1444–1450Google Scholar
  26. 26.
    Nishioka H, Fukuhara N, Yamaguchi-Okada M, Yamada S (2016) Endoscopic endonasal surgery for purely intra-third ventricle craniopharyngioma. World Neurosurg. doi:10.1016/j.wneu.2016.04.042 PubMedGoogle Scholar
  27. 27.
    Reisch R, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57(4 Suppl):242-255-255Google Scholar
  28. 28.
    Rhoton AL (2002) The lateral and third ventricles. Neurosurgery 51(4 Suppl):S207–S271PubMedGoogle Scholar
  29. 29.
    Salma A, Ammirati M (2012) Real time parallel intraoperative integration of endoscopic, microscopic, and navigation images: a proof of concept based on laboratory dissections. J Neurol Surg B Skull Base 73(1):36–41CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Silva PS, Cerejo A, Polónia P, Pereira J, Vaz R (2013) Trans-lamina terminalis approach for third ventricle and suprasellar tumours. Clin Neurol Neurosurg 115(9):1745–1752CrossRefPubMedGoogle Scholar
  31. 31.
    Spena G, Fasel J, de Tribolet N, Radovanovic I (2008) Subfrontal endoscopic fenestration of lamina terminalis: an anatomical study. Minim Invasive Neurosurg 51(6):319–323CrossRefPubMedGoogle Scholar
  32. 32.
    Yaşargil MG, Abdulrauf SI (2008) Surgery of intraventricular tumors. Neurosurgery 62(6 Suppl 3):1029-1040-1041Google Scholar

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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