Endoscopic Configuration of the Anterior Floor of the Third Ventricle in Relation to the Time of Hydrocephalus

https://doi.org/10.59156/revista.v37i03.487

Abstract

Background: Variants in the anatomy of the floor of the third ventricle (PTV) are determining factors in the limitations and complications of endoscopic third ventriculostomy (EVT).

Objective: Describe anatomical variations of the PTV found in cases of hydrocephalus, evaluate incidence, stratify them according to time of evolution and correlate them with surgical difficulty.

Methods: Retrospective analysis of intraoperative videos of n=62 cases of hydrocephalus treated during the period 2015-2020 in our center. Including n=51 cases where the PTV could be clearly evidenced in the images.

Results: We identified 10 PTV varieties out of the 14 described in the bibliography; opaque floor 54.9%, partially erased 29.4%, reduced prepontine interval 23.5%, narrow floor 17.6%, herniated floor 17.65%, thin floor 11.76%. In acute hydrocephalus, the opaque floor (71.8%) and the narrow floor (25%) prevailed. In the chronicle, the thin floor predominated (31.5%), which was demonstrated exclusively in this category. In the patients who underwent an EVT (43 of 51), the degree of surgical difficulty was 15 times greater in those who presented an opaque floor (p < 0.00041) and less in those who presented an opaque floor. partially erased (OR of 0.0615; p 0.00092).

Conclusion: Anatomical variations of the third ventricle are frequent in hydrocephalic patients. Those related to the thickness of the floor can increase the surgical risk. This characteristic cannot be seen in pre-surgical studies, but it is possible to predict it knowing the time of the hydrocephalus clinic and observing the disposition of the mammillary bodies in the cranial resonance.