Abstract
Purpose
Endoscopic third ventriculostomy (ETV) has become first-line treatment for obstructive hydrocephalus. Many complications have been described, but the literature about oculomotor palsy after ETV is scarce. Therefore we undertook an anatomical study of the relationship of the oculomotor nerve to the floor of the third ventricle.
Methods
Distances and angles between the third nerve and the bottom of the third ventricle were studied both in two cadaver heads and in high-definition CISS images in 16 MRI scans. The angles of the trajectories putting the nerve at risk or not were compared. Finally, in a retrospective analysis of intraoperative images the appearance of the membranous portion of the floor was defined and if visible, the distance of the third nerve to the midline was estimated by comparing with the 8-mm balloon catheter.
Results
The course of the third nerve is approximately 8 mm laterally and approximately 17 mm caudally distant from the midpoint of the floor of the third ventricle. The angle of the trajectory to damage the third nerve is at least 12° greater than any safe angle of ETV trajectory through a normal burr hole.
Conclusions
The third nerve is not always visible during ETV procedures, but the angular and linear measurements imply that the risk to damage the nerve should be relatively small. Confirmation of these data in hydrocephalic patients with distorted anatomy is needed.
Similar content being viewed by others
References
Hellwig D, Grotenhuis JA, Tirakotai W, Riegel T, Schulte DM, Bauer BL, Bertalanffy H (2005) Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev 28:1–34
Jallo GI, Kothbauer KF, Abbott IR (2005) Endoscopic third ventriculostomy. Neurosurg Focus 19:E11
Cinalli G, Spennato P, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC et al (2007) Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23:633–644
Dusick JR, McArthur DL, Bergsneider M (2008) Success and complication rates of endoscopic third ventriculostomy for adult hydrocephalus: a series of 108 patients. Surg Neurol 69:5–15
Erşahin Y, Arslan D (2008) Complications of endoscopic third ventriculostomy. Childs Nerv Syst 24:943–948
Navarro R, Gil-Parra R, Reitman AJ, Olavarria G, Grant JA, Tomita T (2006) Endoscopic third ventriculostomy in children: early and late complications and their avoidance. Childs Nerv Syst 22:506–513
Peretta P, Ragazzi P, Galarza M, Genitori L, Giordano F, Mussa F, Cinalli G (2006) Complications and pitfalls of neuroendoscopic surgery in children. J Neurosurg 105:187–193
Schroeder HW, Niendorf WR, Gaab MR (2002) Complications of endoscopic third ventriculostomy. J Neurosurg 96:1032–1040
Schroeder HW, Oertel J, Gaab MR (2004) Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst 20:878–883
Jödicke A, Berthold LD, Scharbrodt W, Schroth I, Reiss I, Neubauer BA, Böker DK (2003) Endoscopic surgical anatomy of the paediatric third ventricle studied using virtual neuroendoscopy based on 3-D ultrasonography. Childs Nerv Syst 19:325–331
Horowitz M, Albright AL, Jungreis C, Levy EI, Stevenson K (2001) Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report. Neurosurgery 49:1461–1464
McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL (1997) Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report. Neurosurgery 41:1400–1403
Jones RF, Kwok BC, Stening WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:28–36
Beems T, Grotenhuis JA (2004) Long-term complications and definition of failure of neuroendoscopic procedures. Childs Nerv Syst 20:868–877
Sleep TE, Elsas F (2007) Strabismus after endoscopic third ventriculostomy. J AAPOS 11:195–196
Kanner A, Hopf NJ, Grunert P (2000) The “optimal” burr hole position for endoscopic third ventriculostomy: results from 31 stereotactically guided procedures. Minim Invasive Neurosurg 43:187–189
Knaus H, Abbushi A, Hoffmann KT, Schwarz K, Haberl H, Thomale UW (2009) Measurements of burr-hole localization for endoscopic procedures in the third ventricle in children. Childs Nerv Syst 25:293–299
Hoving EW, Rahmani M, Los LI, Renardel de Lavalette VW (2009) Bilateral retinal hemorrhage after endoscopic third ventriculostomy: iatrogenic Terson syndrome. J Neurosurg 110:858–860
Cahill M, Bannigan J, Eustace P (1996) Anatomy of the extraneural blood supply to the intracranial oculomotor nerve. Br J Ophthalmol 80:177–181
Marinković S, Gibo H (1994) The neurovascular relationships and the blood supply of the oculomotor nerve: the microsurgical anatomy of its cisternal segment. Surg Neurol 42:505–516
Abuzayed B, Tanriover N, Gazioglu N, Kadafar AM, Akar Z (2010) Endoscopic anatomy of the oculomotor nerve: defining the blind spot during endoscopic skull base surgery. Childs Nerv Syst 26:689–696
Iaconetta G, de Notaris M, Cavallo LM, Benet A, Ensenat J, Samii M, Ferrer EE, Cappabianca P-G (2010) The oculomotor nerve: microanatomical and endoscopic study. Neurosurgery 66:593–601
Kunz M, Schulte-Altedorneburg G, Uhl E, Schmid-Elsaesser R, Schöller K, Zausinger S (2008) Three-dimensional constructive interference in steady-state magnetic resonance imaging in obstructive hydrocephalus: relevance for endoscopic third ventriculostomy and clinical results. J Neurosurg 109:931–938
Iaccarino C, Tedeshi E, Rapana A, Massarelli I, Belfiore G, Quarantelli M, Belotti M (2009) Is the distance between mammillary bodies predictive of a thickened third ventricle floor? J Neurosurg 110:852–857
Scholz M, Mielke D, Fricke B, Pechlivanis I, Engelhardt M, Schmieder K, Harders AG (2007) Individualized ventriculostomy in hydrocephalus: an intravital anatomical study. Neurology India 55:355–362
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Buelens, E., Wilms, G., van Loon, J. et al. The oculomotor nerve: anatomic relationship with the floor of the third ventricle. Childs Nerv Syst 27, 943–948 (2011). https://doi.org/10.1007/s00381-010-1317-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-010-1317-5