Transcallosal-Transseptal-Interfornicial Approach to a Tumor of the Third Ventricle

  • Giuseppe Cinalli
  • Giuseppe Mirone

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The video describes the partial removal of an optic pathways glioma in a 17-month old baby presenting with gait disturbances and torticollis. The pre-operative MRI revealed the presence of a large mass in the optic chiasm and hypothalamic area, extending postero-superiorly into the third ventricle, occluding both foramens of Monro and inducing supratentorial hydrocephalus, that was treated by implant of a ventriculo-peritoneal shunt; it also showed the presence of a relatively large cyst of the septum pellucidum and multiple small nodules disseminated in the ventricular cavities and through the intracranial and spinal subarachnoid spaces. All the options to surgical approach to this tumor are analyzed on the basis of the pre-operative MR imaging.


The prevalent cranio-caudal expansion of the tumor, the presence of a large ventricular dilatation that dictated the necessity to open both foramens of Monro to restore CSF circulation, and above all the presence of the septal cyst, contributed to the choice of the transcallosal-transeptal-interforniceal approach. The different steps of the approach are described: Interhemispheric dissection, identification and dissection of pericallosal arteries, callosotomy, identification of the cyst of the septum pellucidum, vertical progression within the cavity of the septal cyst, identification of the thela chorioidea and of the two components of the fornix, coagulation of the thela, identification and dissection of the internal cerebral veins, entry into the third ventricle, dissection of the tumor from the third ventricle ependyma, internal debulking of the tumor until removal of approximately 70% of the tumor volume remaining above the hypothetic plan of the optic pathways. MRI after the procedure showed adequate debulking of the tumor, that histology confirmed as pilomyxoid astrocytoma.

About The Author

Giuseppe Cinalli

Dr. Giuseppe Cinalli is Chief of the Department of Pediatric Neurosurgery and of the Department of Neurosciences at the Santobono-Pausilipon Children’s Hospital, where he began working in October 1999. He started the residency program in Neurosurgery at the “Federico II” University in Naples, and completed it at the Department of Pediatric Neurosurgery of the Hôpital Necker Enfants Malades in Paris, France. In 1993, he spent a period as a visiting fellow at the Department of Pediatric Neurosurgery of the New York University Medical Center directed by Fred Epstein, and at the Department of Pediatric Neurosurgery of the Primary Children’s Medical Center of Salt Lake City directed by Marion “Jack” Walker. In the same year, he began his University career in France as Chef de Clinique-Assistant and later as Praticien Hospitalo-Universitaire. He is an active member of 7 scientific societies, has written 116 indexed papers, edited 4 books, and is a founding member of the International Study Group on Neuro Endoscopy (ISGNE), which later became the International Federation of Neuroendoscopy (IFNE). In 2017, he was elected President of the IFNE for a two-year term.


Dr. Giuseppe Mirone is a Neurosurgeon in the same department, After his residency in neurosurgergy in Naples, he was visiting resident at the Department of Neurological Surgery, University of California at San Francisco (UCSF) and completed his training following clinical and research stages in Boston, Marmara, Paris. His main areas of interest are neuroendoscopy, skull base surgery, central and spinal nervous system surgery, functional neurosurgery for movement disorders.


About this video

Giuseppe Cinalli
Giuseppe Mirone
Online ISBN
Total duration
31 min
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript


In this video, we will show the transcallosal transseptal interfornical approach to the third ventricle. I’m Giuseppe Cinalli, director of pediatric neurosurgery at Santobono-Pausilipon Children’s Hospital in Naples, Italy. The video describes the surgical approach performed to achieve a partial removal of an optic pathways glioma in a 17-month-old baby presenting with gait disturbances and torticolis. The MRI revealed the presence of a large mass in the optic chiasm in the hypothalamic area, occluding both foramens of Monro, inducing hydrocephalus.

Hydrocephalus was treated with a ventriculo-peritoneal shunt. MRI showed, in addition, the presence of a cyst of the septum pellucidum, and multiple nodules disseminate in the ventricular cavities, and through the intracranial and the spinal spaces. The patient had a nice postoperative result. Postoperative MRI showed adequate debunking of the tumor. Histology confirmed as disseminated pilomyxoid astrocytoma, the patient did not develop any postoperative deficit. The chemotherapy protocol for low grade glioma was started, and follow up MRI at one year showed further reduction of the residual mass.