{"id":"a8b74f5d-465a-4558-ac19-11999ae153cb","slug":"mastering-third-ventricle-surgery-through-anatomical-laboratory-knowledge","title":"Mastering third ventricle surgery through anatomical laboratory knowledge","authors":["Luis Alberto Nuñez del Arco Serrano","Héctor Osvaldo Hernández Velázquez","Francisco Javier Medina Anderson","Galo Eduardo Sánchez Borrero","Alejandro Benjamin Romero Leguina","Mariano Teyssandier","Erica Antunes Effgen","Érico Samuel Gomes Galvão da Trindade","José Maria de Campos Filho","Feres Chaddad-Neto"],"abstract":"Background: A thorough understanding of third ventricle anatomy is essential for safe and effective surgical planning, particularly for lesions in this deep and complex brain region. The ventricle is surrounded by critical neurovascular structures, whose variability can significantly influence the choice of surgical approach and the risk of complications. Anatomical knowledge, supported by cadaveric dissection and imaging, enables surgeons to anticipate challenges, minimize risks, and improve outcomes. This is especially important for third ventricular tumors, where errors may lead to neurological deficits due to injury of hypothalamic or vascular structures. Case Description: We present the case of a 19-year-old male presenting with clinical signs of hydrocephalus. Imaging revealed a tumor within the third ventricle. This video illustrates its surgical management, highlighting the importance of anatomical familiarity and proper approach selection. The approach was based on detailed anatomical insights, reinforced by cadaveric dissections. Anterior and inferior approaches to the subcallosal region carry a risk of damaging branches of the anterior cerebral artery (ACA), particularly the hypothalamic and subcallosal branches. Injury in these areas can result in memory deficits, amnestic-confabulatory syndrome, or hypothalamic dysfunction. To minimize these risks, we employed a bimanual interhemispheric transrostral approach. This technique provides controlled access to the floor of the third ventricle and hypothalamus through three anatomical windows. The integration of anatomical expertise, surgical strategy, and laboratory training is essential to achieve safe and effective outcomes in third ventricular surgery. The patient experienced no complications and showed progressive neurological recovery. Conclusion: This case highlights the essential role of thorough third ventricle anatomical knowledge in planning safe and effective surgery. Laboratory-based training, including cadaveric dissections, allows surgeons to practice complex maneuvers, refine technical skills, and anticipate challenges before operating on patients. Combining deep anatomical understanding with hands-on practice is key to minimizing complications and achieving optimal outcomes in these high-risk procedures. Timed Annotations[ 1 - 9 ] 1) 00:08 - Clinical presentation and imaging findings. 2) 00:57 - Rationale for the procedure, possible risks and benefits, and alternatives. 3) 03:35 - Description of the setup (positioning, equipment, key surgical steps). 4) 04:11 - Craniotomy and interhemispheric approach. 5) 04:29 - Exposure of the pericallosal artery and corpus callosum. 6) 05:04 - Entry into the left lateral ventricle. 7) 05:29 - Identification of the tumor through the left foramen of Monro. 8) 05:58 - Entry into the right lateral ventricle. 9) 06:22 - Identification of the tumor through the right foramen of Monro. 10) 06:43 - Approach through the rostrum of the corpus callosum. 11) 06:52 - Identification of the tumor through the rostrum of the corpus callosum. 12) 07:30 - Disease background. 13) 07:45 - Imaging and clinical outcome. 14) 08:11 - Conclusion. The research/study was approved by the Institutional Review Board at the Research and Ethics Committee of the Federal University of São Paulo, number 55371222.8.0000.5505, dated June 27, 2024. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. https://doi.org/10.25259/SNI_690_2025 The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/skull-base.png","publishDate":"2025-11-21T00:00:00.000Z","doi":"10.25259/SNI_690_2025","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/a8b74f5d-465a-4558-ac19-11999ae153cb/pdf"}