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Dissection of the choroidal fissure
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Corpus callosum is exposed. It is coagulated and incised according to the trajectory planned on neuronavigation. Lateral ventricle is entered and explored to check for surgical landmarcks: choroid plexus, thalamo-striate vein and foramen of Monro.
Keywords
- Corpus callosum
- septum pellucidum
- lateral ventricle
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Giuseppe Cinalli
- Pietro Spennato
- First online
- 19 February 2022
- DOI
- https://doi.org/10.1007/978-3-030-95506-9_2
- Online ISBN
- 978-3-030-95506-9
- Publisher
- Springer, Cham
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
Video Transcript
Then we continue with the callosotomy. Callosotomy is easy when the corpus callosum is relatively thin after years of chronic hydrocephalus. And with the quite large ventricular system, we can coagulate the almost avascular corpus callosum in this part.
In the depth, we identify the bluish ependyma that protected the cavity of the ventricular system. And after identifying the ependyma, we incise the ependyma, taking care of not injuring the ependymal vessels that can be present immediately before the entering into the ventricular system. Identifying and protecting these small vessels during the callosotomy is important in order to avoid remote bleeding.
In this case, it was the posterior septal vein that can be identified also on the preoperative MRI. We isolated this vein before sacrificing it. Of course it is important to sacrifice this vein in order to avoid remote bleeding during the progression of our surgical instruments.
After completion of the callosotomy, we continue with the opening. The cavity of the right lateral ventricle is very clear. We continue our dissection by repositioning the self-retaining retractor on the right side inside the callosotomy in order to keep protected the right pericallosal arteries. In this case, we have decided to sacrifice the posterior septal vein because it’s a vein that can be sacrificed with impunity. And keeping it in the back of our surgical trajectory can create small hemorrhage during further work in the depth of our surgical field.
After sacrifice of the posterior septal vein, we can see very clearly the choroid plexus that covers the choroid fissure. We replace our self-retaining retractor in order to protect also the left pericallosal arteries during our work in the depth of the surgical field.
And we increase the magnification at the level of the posterior edge of the foramen of Monro. And we dissect the posterior part of the foramen of Monro. We can see the anterior septal vein. We can see the choroid plexus and the anterior pillar of the fornix delimiting anteriorly the foramen of Monro.