- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
Alicia Del Carmen Becerra Romero
Department of Neurology, Division of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
DOI:10.4103/2152-7806.82373Copyright: © 2011 Romero ADCB. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Becerra Romero AD C, da Silva CE, de Aguiar PH P. The distance between the posterior communicating arteries and their relation to the endoscopic third ventriculostomy in adults: An anatomic study. Surg Neurol Int 30-Jun-2011;2:91
How to cite this URL: Becerra Romero AD C, da Silva CE, de Aguiar PH P. The distance between the posterior communicating arteries and their relation to the endoscopic third ventriculostomy in adults: An anatomic study. Surg Neurol Int 30-Jun-2011;2:91. Available from: http://sni.wpengine.com/surgicalint_articles/the-distance-between-the-posterior-communicating-arteries-and-their-relation-to-the-endoscopic-third-ventriculostomy-in-adults-an-anatomic-study/
Background:The diencephalic leaf of the Liliequist's membrane is a continuous structure that should be perforated in the endoscopic third ventriculostomy. Its lateral borders are penetrated by the third cranial nerve and the posterior communicating arteries. The most important complication of endoscopic third ventriculostomy is the vascular injury, such as the posterior communicating artery. The purpose of this study is to measure the distance between posterior communicating arteries located below the third ventricle floor and anterior of the mammillary bodies.
Methods:In this observational prospective study 20 fresh brains from cadavers were utilized to measure the distance between the posterior communicating arteries in April 2008 at the Death Check Unit of our Institution. A digital photograph of the posterior communicating arteries was taken and the distance between the arteries was measured. The measurement was analyzed using descriptive statistics.
Results:In the descriptive analysis of the 20 specimens, the posterior communicating arteries distance was 9 to 18.9 mm, a mean of 12.5 mm, median of 12.2 mm, standard deviation of 2.3 mm.
Conclusion:The detailed knowledge of vascular structures involved in the endoscopic third ventriculostomy as to the posterior communicating arteries distance provides a safe lateral vascular border when performing such procedure.
Keywords: Cerebral arteries, neuroanatomy, neuroendoscopy, posterior communicating artery, ventriculostomy
The modern technique of endoscopic third ventriculostomy (ETV) is based on the concept of establishing a channel for the cerebrospinal fluid through the third ventricle floor. The diencephalic leaf of Liliequist's membrane is a continuous structure that has to be perforated after the third ventricle floor fenestration in ETV. Brasil and Schneider,[
In this observational prospective study 20 fresh brains from cadavers were utilized, whose cause of death was assessed at the Death Check Unit (DCU) of our Institution. In April 2008 adult humans between 33 and 88 years, were included, the median age was 67. Twelve were male and eight female. The adult cadavers were randomly selected from those submitted to necropsy at the DCU for diagnoses of cause of death, cadavers where the cause of death was brain diseases, where excluded from the study. This study was approved by the Ethics Committee of our Institution. The research protocol number is 0363/07. Time of death and study varied between 8 to 25 hours. The skull cap was removed and the dura mater was incised. A transverse incision was made in the midbrain at the level of the tentorial notch. The brains were removed from the cranial cavities in one piece. The cerebral arteries were not filled with coloured latex. The PCoAs were exposed. A photograph of the distance between the PCoAs, anterior of the mammillary bodies was taken with a digital camera and a ruler was placed to provide a reference to the dimension [
The results of each specimen studied are given [
We chose to do the measurement through digital photogrametry because of the contact with the instruments during the direct measurement of tissues that have soft tissue properties that could deform the surface and would lead to an inaccurate measurement.[
Schroeder and other authors recommend that the perforation of the third ventricle floor should be done in the halfway between the infundibular recess and the mammillary bodies in the midline.[
The ETV is held mainly in the pediatric population, however it is not only in this age group. This research utilizes adult corpses with ages varying between 33 and 88 years. Buxton et al reports ages between 17 and 77 years in adult hydrocephalus submitted to the ETV.[
In the interpretation of the PCoAs distance results, we should consider a possible bias due to a postmortem changing of arterial diameter, since we did not used arterial injection and the arterial border was used as lateral measurement.
The posterior communicating artery originates from the dorsal aspect of the carotid siphon and follows posteromedial, inferior to the optic tract and the floor of the third ventricle and joins the posterior cerebral artery.[
On completion of the ETV, not only the dimensions of the third ventricle are important, but also detailed knowledge of the vascular structures involved and also the distance between the PCoAs. This provides a maximum lateral vascular limit when performing the third ventriculostomy.
1. Bergland RM, Ray BS, Torack RM. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg. 1968. 28: 93-9
2. Brasil AV, Schneider FL. Anatomy of Liliequist membrane. Neurosurgery. 1993. 32: 956-61
3. Buxton N, Ho KJ, Macarthur D, Vloeberghs M, Punt J, Robertson I. Neuroendoscopic third ventriculostomy for hydrocephalus in adults: Report of a single unit´s experience with 63 cases. Surg Neurol. 2001. 55: 74-8
4. Çataltepe O. Endoscopic third ventriculostomy: Indications, surgical technique, and potential problems. Turk Neurosurg. 2002. 12: 65-73
5. Gabrovsky N. Microanatomical bases for intraoperative division of the posterior communicating artery. Acta Neurochir (Wien). 2002. 144: 1205-11
6. Gibo H, Kenkey C, Rhoton AL. Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg. 1981. 55: 560-74
7. Jallo GI, Kothbauer KF, Abbott IR. Endoscopic third ventriculostomy. Neurosurg Focus. 2005. 19: E11-
8. Kamath S. Observations on the length and diameter of the vessels forming the circle of Willis. J Anat. 1981. 133: 419-23
9. Kelly PJ. Stereotactic third ventriculostomy in patients with nontumoral adolescent /adult onset aqueductal stenosis and symptomatic hydrocephalus. J Neurosurg. 1991. 75: 865-73
10. Klapecki J, Pacholec E, Ciszek B. Anatomy of the posterior communicating artery - preliminary report. Folia Morphol(Warsz). 1996. 55: 335-7
11. Lü J, Zhu X. Microsurgical anatomy of the interpeduncular cistern and related arachnoid membranes. J Neurosurg. 2005. 103: 337-41
12. Lü J, Zhu XI. Microsurgical anatomy of Liliequist's membrane. Minim Invasive Neurosurg. 2003. 46: 149-54
13. Massimi L, Di Rocco C, Tamburrini G, Caldarelli M, Iannelli A. Terzo-ventricolostomia endoscopica-complicazioni e fallimenti. Minerva Pediatr. 2004. 56: 167-81
14. Navarro R, Gil-Parra R, Reitman AJ, Olavarria G, Grant JA, Tomita T. Endoscopic third ventriculostomy in children: Early and late complications and their avoidance. Childs Nerv Syst. 2006. 22: 506-13
15. Reddy DR, Prabhakar V, Rao BD. Anatomical study of circle of Willis. Neurol India. 1972. 20: 8-12
16. Rhode V, Gilsbach JM. Anomalies and variants of the endoscopic anatomy for third ventriculostomy. Minim Invasive Neurosurg. 2000. 43: 111-7
17. Rhoton AL. The lateral and third ventricles. Neurosurgery. 2002. 51: 209-72
18. Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy. J Neurosurg. 2002. 96: 1032-40
19. Taveras JM.editors. Angiography. Baltimore: Williams and Wilkins; 1996. p.
20. Tunali S. Digital photogrammetry in neuroanatomy. Neuroanatomy. 2008. 7: 47-8
21. Uz A, Mine EK. A morphological study of the posterior communicating artery. Folia Morphol (Warsz). 2004. 63: 397-9
22. Vincentelli F, Caruso G, Grisoli F, Rabehanta P, Andriamamonjy C, Gouaze A. Microsurgical anatomy of the cisternal course of the perforating branches of the posterior communicating artery. Neurosurgery. 1990. 26: 824-31
23. Walker ML. Complications of third ventriculostomy. Neurosurg Clin N Am. 2004. 15: 61-6
24. Yamamoto I, Rhoton AL, Peace D. Microsurgery of the third ventricle: Part 1.Microsurgical anatomy. Neurosurgery. 1981. 8: 334-56