Marking Basilar Artery Using Neuronavigation During Endoscopic Third Ventriculostomy: A Clinical Study

AIM: To evaluate the efficacy of using a neuronavigation system for demonstrating the relationship between the basilar artery (BA)and ventricular floor during endoscopic third ventriculostomy (ETV).MATERIAL and METHODS: Records of 28 patients (16 females and 12 males) diagnosed with obstructive hydrocephalus whohad undergone a neuroendoscopic procedure were retrospectively examined. Patient age ranged from 1 to 76 years (median 24.46years). The BA was marked with using the neuronavigation system in all cases to visualise its relationship to the floor of the thirdventricle in real time.RESULTS: ETV was successfully performed in 28 patients with obstructive hydrocephalus. Of these, 13 (46.4%) patients had athickened tuber cinereum (TC) membrane and 3 (10.7%) showed lateralization of the BA under the ventricular floor. No contact withthe BA or related complications (e.g., major bleeding) was encountered with BA marking by using neuronavigation.CONCLUSION: Even though thickening of the TC membrane and/or displacement of the BA might be seen otherwise, we describe anew method that combines marking the BA and using neuronavigation to provide greater safety in the area where the ventriculostomywill be performed. This permits clearer orientation for the surgeon which significantly contributes to minimizing surgical morbidity.


1. Alberti O, Riegel T, Hellwig D, Bertalanffy H: Frameless navigation and endoscopy. J Neurosurg 95:541–543, 2001

2. Amini A, Schmidt RH: Endoscopic third ventriculostomy in a series of 36 adult patients. Neurosurg Focus 19:E9, 2005

3. Bilginer B, Oguz KK, Akalan N: Endoscopic third ventriculostomy for malfunction in previously shunted infants. Childs Nerv Syst 25:683–688, 2009

4. Boschert J, Hellwig D, Krauss JK: Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: Long-term follow up and review. J Neurosurg 98:1032–1039, 2003

5. Brockmeyer D: Techniques of endoscopic third ventriculostomy. Neurosurg Clin N Am 15:51–59, 2004

6. Buxton N, Punt J: Cerebral infarction after neuroendoscopic third ventriculostomy: Case report. Neurosurgery 46:999– 1001, 2000

7. Constantini S, Mohanty A, Zymberg S, Cavalheiro S, Mallucci C, Hellwig D, Ersahin Y, Mori H, Mascari C, Val JA, Wagner W, Kulkarni AV, Sgouros S, Oi S: Safety and diagnostic accuracy of neuroendoscopic biopsies: An international multicenter study. J Neurosurg Pediatr 11:704–709, 2013

8. Eboli P, Shafa B, Mayberg M: Intraoperative computed tomography registration and electromagnetic neuronavigation for transsphenoidal pituitary surgery: Accuracy and time effectiveness. J Neurosurg 114:329–335, 2011

9. El-Ghandour NM: Endoscopic treatment of intraparenchymal arachnoid cysts in children. J Neurosurg Pediatr 14:501–507, 2014

10. Etus V, Guler TM, Karabagli H: Third ventricle floor variations and abnormalities in myelomeningocele associated hydrocephalus: Our experience with 455 endoscopic third ventriculostomy procedures. Turk Neurosurg 27(5):768-771, 2017

11. Etus V, Solakoglu S, Ceylan S: Ultrastructural changes in the Liliequist membrane in the hydrocephalic process and its implications for the endoscopic third ventriculostomy procedure. Turk Neurosurg 21(3):359-366, 2011

12. Fiorindi A, Delitala A, Francaviglia N, Longatti P: Neuroendoscopic options in the treatment of mesencephalic expanding cysts: Report of four cases and review of the literature. Clin Neurol Neurosurg 115:2370–2376, 2013

13. Golfinos JG, Fitzpatrick BC, Smith LR, Spetzler RF: Clinical use of a frameless stereotactic arm: Results of 325 cases. J Neurosurg 83:197–205, 1995

14. Hayashi N, Endo S, Hamada H, Shibata T, Fukuda O, Takaku A: Role of preoperative midsagittal magnetic resonance imaging in endoscopic third ventriculostomy. Minim Invasive Neurosurg 42:79–82, 1999

15. Hermann EJ, Esmaeilzadeh M, Ertl P, Polemikos M, Raab P, Krauss JK: Endoscopic intracranial surgery enhanced by electromagnetic-guided neuronavigation in children. Childs Nerv Syst 31:1327–1333, 2015

16. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A: Endoscopic third ventriculostomy: Outcome analysis of 100 consecutive procedures. Neurosurgery 45:957–959, 1999

17. Horsburgh A, Matys T, Kirollos RW, Massoud TF: Tuber cinereum proximity to critical major arteries: A morphometric imaging analysis relevant toendoscopic third ventriculostomy. Acta Neurochir (Wien) 155:891-900, 2013

18. Iaccarino C, Tedeschi E, Rapanà A, Massarelli I, Belfiore G, Quarantelli M, Bellotti A: Is the distance between mammillary bodies predictive of a thickened third ventricle floor? J Neurosurg 110:852–857, 2009

19. Karabatsou K, Hayhurst C, Buxton N, O’Brien DF, Mallucci CL: Endoscopic management of arachnoid cysts: An advancing technique. J Neurosurg 106:455–462, 2007

20. Kim K, Yeon JY, Seol HJ, Shin HJ: Transventricular endoscopic biopsy of suprasellar tumors: A pediatric case series. Childs Nerv Syst 29:1285–1291, 2013

21. Kim SK, Wang KC, Cho BK: Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: Prognostic factors and interpretation of postoperative neuroimaging. Childs Nerv Syst 16:161–168, 2000

22. Kinfe TM, Capelle HH, Mirzayan MJ, Boschert J, Weigel R, Krauss JK: Stereotactic versus endoscopic surgery in periventricular lesions. Acta Neurochir (Wien) 153:517–526, 2011

23. Knaus H, Matthias S, Koch A, Thomale UW: Single burrhole endoscopic biopsy with third ventriculostomy-measurements and computer-assisted planning. Childs Nerv Syst 27:1233– 1241, 2011

24. Kulkarni AV, Sgouros S, Constantini S, Investigators I: International infant hydrocephalus study: Initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst 32(6):1039–1048, 2016

25. Luther N, Cohen A, Souweidane MM: Hemorrhagic sequelae from intracranial neuroendoscopic procedures for intraventricular tumors. Neurosurg Focus 19:E9, 2005

26. Martínez-Moreno M, Widhalm G, Mert A, Kiesel B, Bukaty A, Furtner J, Reinprecht A, Knosp E, Wolfsberger S: A novel protocol of continuous navigation guidance for endoscopic third ventriculostomy. Neurosurgery 10 Suppl 4:514–523, 2014

27. McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL: Traumatic basilar aneurysm after endoscopic third ventriculostomy: Case report. Neurosurgery 41:1400–1404, 1997

28. McMillen JL, Vonau M, Wood MJ: Pinless frameless electromagnetic image-guided neuroendoscopy in children. Childs Nerv Syst 26:871–878, 2010

29. Oka K, Go Y, Kin Y, Tomonaga M: An observation of the third ventricle under flexible fiberopticventriculoscope: Normal structure. Surg Neurol 40:273–277, 1993

30. Paraskevopoulos D, Biyani N, Constantini S, BeniAdani L: Combined intraoperative magnetic resonance imaging and navigated neuroendoscopy in children with multicompartmental hydrocephalus and complex cysts: A feasibility study. J Neurosurg Pediatr 8:279–288, 2011

31. Peltier J, Fichten A, Page C, Havet E, Foulon P, Mertl P, Le Gars D, Laude M: Endoscopic anatomy of the terminal portion of the basilar artery and its distal perforating branches. Morphologie 92:31–36, 2008

32. Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG: Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: Results from a Swiss series and literature review. Childs Nerv Syst 23:527–533, 2007

33. Rohde V, Gilsbach JM: Anomalies and variants of the endoscopic anatomy for third ventriculostomy. Minim Invasive Neurosurg 43:111–117, 2000

34. Romero AC, Aguiar PH, Borchartt TB, Conci A: Quantitative ventricular neuroendoscopy performed on the third ventriculostomy: Anatomic study. Neurosurgery 68 Suppl Operative 2:347–354, 2011

35. Sangra M, Clark S, Hayhurst C, Mallucci C: Electromagnetic guided neuroendoscopy in the pediatric population. J Neurosurg Pediatr 3:325–330, 2009 36. Schroeder HW, Gaab MR, Niendorf WR: Neuroendoscopic approach to arachnoid cysts. J Neurosurg 85:293–298, 1996

37. Schroeder HW, Warzok RW, Assaf JA, Gaab MR: Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy. J Neurosurg 90:153–155, 1999

38. Schroeder HWS, Niendorf WR, Gaab MR: Complications of endoscopic third ventriculostomy. J Neurosurg 96:1032–1040, 2002

39. Schulz M, Bohner G, Knaus H, Haberl H, Thomale UW: Navigated endoscopic surgery for multiloculated hydrocephalus in children. J Neurosurg Pediatr 5:434–442, 2010

40. Sieśkiewicz A, Łysoń T, Mariak Z, Rogowski M: Neuronavigation in transnasal endoscopic paranasal sinuses and cranial base surgery: Comparison of the optical and electromagnetic systems. Otolaryngol Pol 63:256–260, 2009

41. Vinas FC, Dujovny N, Dujovny M: Microanatomical basis for the third ventriculostomy. Minim Invasive Neurosurg 39:116– 121, 1996

42. Yadav YR, Parihar VS, Ratre S, Kher Y: Avoiding complications in endoscopic third ventriculostomy. J Neurol Surg A Cent Eur Neurosurg 76:483–494, 2015

43. Yildirim AE, Karaoglu D, Divanlioglu D, Belen AD: A difficult endoscopic third ventriculostomy procedure: Perforation of a thick Liliequist membrane with high basilar artery location. Turk Neurosurg 24(6):946-947, 2014

44. Zhang C, Detre JA, Kasner SE, Cucchiara B: Basilar artery lateral displacement may be associated with migraine with aura. Front Neurol 9:80, 2018

Kaynak Göster

Turkish Neurosurgery
  • ISSN: 1019-5149
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1989


Sayıdaki Diğer Makaleler

Artificial Total Disc Replacement Versus Fusion for Lumbar Degenerative Disc Disease: An Update Systematic Review and Meta-Analysis

Yu Zhe LI, Piao SUN, Dong CHEN, Li TANG, Chun Hui CHEN, Ai-Min WU

Successful Application of the Ventriculo-Gallbladder Shunt: A Salvage Procedure


Use of Muscle Graft versus Fascia Flap as Interpositional Material in Prevention of Reossification in a Rat Model of Skull Bone Defect

Ayhan OKUMUŞ, Erdem GÜVEN, İsmail ERMİŞ, Vakur OLGAÇ, Murat TOPALAN, Metin ERER

Association of Two Primitive Carotid-Basilar Anastomoses and Cerebrovascular Abnormalities on the Brain Base: A Case Report


Long-Term Outcomes of Pediatric Meningioma Surgery: Single Center Experience with 23 Patients


Marking Basilar Artery Using Neuronavigation During Endoscopic Third Ventriculostomy: A Clinical Study


The Association between the Timing of Shunt Placement and Shunt Infection in Hydrocephalus Associated with Myelomeningocele

Mehmet Sabri GURBUZ, Mehmet Onur YUKSEL

Septum Pellucidum Cavernoma: A Case Report and Anatomical Consideration of an Extremely Rare Lesion

Aline Lariessy CAMPOS PAIVA, Renan Maximillian LOVATO, Jo o Luiz VITORINO ARAUJO, Jos Carlos ESTEVES VEIGA

Does Really Level of Transforaminal Epidural Steroid Injection Affect the Treatment Outcome?

Mehmet Cetin BASKAYA