Anatomy of the cerebral ventricular system for endoscopic neurosurgery: a magnetic resonance study

Acta Neurochir (2003) 145: 359368 DOI 10.1007/s00701-003-0021-6

Clinical ArticleAnatomy of the cerebral ventricular system for endoscopic neurosurgery: a magnetic resonance study

F. Duffner1, H. Schiffbauer1, D. Glemser1, M. Skalej2, and D. Freudenstein1

1 Department of Neurosurgery, Eberhard-Karls-University and University Hospital Tuubingen, Germany

2 Department of Neuroradiology, Eberhard-Karls-University and University Hospital Tuubingen, Germany

Published online June 4, 2003 # Springer-Verlag 2003

Summary

Background. Endoscopy has developed into an integral part of minimally invasive neurosurgery. For further technological innovations, detailed knowledge about the pathological anatomy is essential. The gross anatomy of the cerebral ventricular system has been meticulously investigated with ventriculography and casts. Extensive volumetric measurements based on neuroradiological images have been performed, but only little is known about the surgically relevant linear distances in patients with hydrocephalus.

Method. Thirty healthy volunteers and thirty patients suffering from hydrocephalus were scanned with high-resolution 3-D magnetic resonance imaging sequences. The image volumes were sliced identically with the help of Siemens Prominence+ software. Individual anatomical measurements of the ventricular system were carried out, mean values and standard deviations were calculated, and different endoscopic approaches were investigated.

Findings. In healthy volunteers the measurements conrmed the results obtained from ventriculography and anatomic casts. In hydrocephalic patients the ventricular system was found to be enlarged asymmetrically. The optimal neuroendoscopic approach showed considerable, interindividual variation.

Interpretation. This 3-D magnetic resonance imaging study revealed surgically and clinically relevant aspects of the pathologic anatomy of hydrocephalic patients, in comparison to healthy volunteers. Individualized planning of the endoscopic approach appears to be warranted. Finally, the data provided a sound basis for the further development of neuroendoscopes.

Keywords: Magnetic resonance imaging; hydrocephalus; neuroendoscopy; neuroanatomy; ventricular size; biomedical engineering.

Introduction

Endoscopy is an integral part of the spectrum of minimally invasive neurosurgery. Technological innovations, such as the development of small endoscopes and associated instruments, adapted to the nervous system,

have improved the safety and efciency of endoscopic neurosurgery. For further development of specic instruments, exact knowledge of the pathological anatomy is required.

Magnetic resonance (MR) imaging allows acquisition of 3-D volume data and measurement of linear distances in any chosen image plane, using recent software. The possibilities offered by the modern imaging methods, new operative approaches and minimally invasive techniques motivated us to revisit the anatomy of the ventricular...