Endoscopic transcortical expanded transforaminal transvenous transchoroidal approach to third ventricle lesion resection using an endoport


      • Preliminary application of combined endoscopy, endoport, and expanded transforaminal transvenous transchoroidal approach with third ventricle tumors.
      • Elaborating the advantages of using endoport technology and recommendations.
      • Putting forward our views and experience on whether to sever the anterior septal vein.
      • Some key points are proposed for the surgical approach.



      To investigate the clinical experience and application value of endoscopic resection of lesions in and around the third ventricle using a transcortical expanded transforaminal transvenous transchoroidal approach with an endoport.


      Clinical data and follow-up results of seven patients who underwent the removal of lesions in the third ventricle and its adjacent area with an endoport-guided endoscopic system from January 2018 to December 2020 in the Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, were analyzed retrospectively. Two other patients from the Affiliated Pediatric Hospital of Fudan University and the Affiliated Hospital of Guizhou Medical University, respectively, were included in the analysis.


      A total of nine cases of third ventricle tumors were included in the study, including six women and three men, with an average age of 37.8 years (4–84 years old) and a follow-up time of 6–44 months. These nine tumor cases included two pilocytic astrocytomas, one diffuse midline glioma (H3 K27-altered), two craniopharyngiomas, two choroid plexus (CP) papillomas, one germinoma, and one pineal parenchymal tumor of intermediate differentiation. Total resection was completed in eight cases, with one near-total resection. There were no complications related to the surgical approach, such as epilepsy, aphasia, or hemiplegia.


      The endoscope transcortical expanded transforaminal transvenous transchoroidal approach using an endoport can safely and effectively remove third ventricle lesions. This approach can reach a wide area, from the anterior to the posterior third ventricle.



      ASV (anterior septal vein), CP (choroid plexus), ICV (internal cerebral vein), TSV (thalamostriate vein)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nagata S.
        • Rhoton A.L.
        • Barry M.
        Microsurgical anatomy of the choroidal fissure.
        Surg Neurol. 1988; 30: 3-59
        • Kelly P.J.
        • Goerss S.J.
        • Kall B.A.
        The stereotaxic retractor in computer-assisted stereotaxic microsurgery. Technical note.
        J Neurosurg. 1988; 69: 301
        • Eichberg D.G.
        • Di L.
        • Shah A.H.
        • Luther E.M.
        • Jackson C.
        • Marenco-Hillembrand L.
        • et al.
        Minimally invasive resection of intracranial lesions using tubular retractors: a large, multi-surgeon, multi-institutional series.
        J Neuro-Oncol. 2020; 149: 35-44
        • Marenco-Hillembrand L.
        • Prevatt C.
        • Suarez-Meade P.
        • Ruiz-Garcia H.
        • Quinones-Hinojosa A.
        • Chaichana K.L.
        Minimally invasive surgical outcomes for deep-seated brain lesions treated with different tubular retraction systems: a systematic review and meta-analysis.
        World Neurosurg. 2020; 143: 537-545
        • Xiaobiao Zhang W.L.
        Endoscopic and navigational minimally invasive operative neurosurgery.
        Fudan University Press, shanghai2019
        • Seo Y.
        • Kim Y.H.
        • Kim J.H.
        • Kong D.-S.
        • Dho Y.-S.
        • Kang H.o.
        • et al.
        Outcomes of the endoscopic endonasal approach for tumors in the third ventricle or invading the third ventricle.
        J Clin Neurosci. 2021; 90: 302-310
        • Cavallo L.M.
        • Solari D.
        • Esposito F.
        • Cappabianca P.
        The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle.
        Neurosurg Rev. 2013; 36: 27-38
        • Krishna V.
        • Blaker B.
        • Kosnik L.
        • Patel S.
        • Vandergrift W.
        Trans-lamina terminalis approach to third ventricle using supraorbital craniotomy: technique description and literature review for outcome comparison with anterior, lateral and trans-sphenoidal corridors.
        Minim Invasive Neurosurg. 2011; 54: 236-242
        • King T.T.
        Removal of intraventricular craniopharyngiomas through the lamina terminalis.
        Acta Neurochir. 1979; 45: 277-286
        • Gu Y.e.
        • Zhang X.
        • Hu F.
        • Yu Y.
        • Xie T.
        • Sun C.
        • et al.
        Suprachiasmatic translamina terminalis corridor used in endoscopic endonasal approach for resecting third ventricular craniopharyngioma.
        J Neurosurg. 2015; 122: 1166-1172
        • Türe U.
        • Yaşargil M.G.
        • Al-Mefty O.
        The transcallosal-transforaminal approach to the third ventricle with regard to the venous variations in this region.
        J Neurosurg. 1997; 87: 706
        • Yaşargil M.G.
        • Abdulrauf S.I.
        Surgery of intraventricular tumors.
        Neurosurgery. 2008; 62 (1040-1041): 1029-1040
        • Wen H.T.
        • Rhoton A.J.
        • de Oliveira E.
        Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application.
        Neurosurgery. 1998; 42 (1217-1219): 1205-1217
        • Ulm A.J.
        • Russo A.
        • Albanese E.
        • Tanriover N.
        • Martins C.
        • Mericle R.M.
        • et al.
        Limitations of the transcallosal transchoroidal approach to the third ventricle.
        J Neurosurg. 2009; 111: 600-609
        • Zemmoura I.
        • Velut S.
        • Francois P.
        The choroidal fissure: anatomy and surgical implications.
        Adv Tech Stand Neurosurg. 2012; 38: 97-113
        • Bozkurt B.
        • Yağmurlu K.
        • Belykh E.
        • Tayebi Meybodi A.
        • Staren M.S.
        • Aklinski J.L.
        • et al.
        Quantitative anatomic analysis of the transcallosal-transchoroidal approach and the transcallosal-subchoroidal approach to the floor of the third ventricle: an anatomic study.
        World Neurosurg. 2018; 118: 219-229
        • Cossu G.
        • González-López P.
        • Daniel R.T.
        The transcallosal transchoroidal approach to the diencephalic-mesencephalic junction: how I do it.
        Acta Neurochir. 2019; 161: 2329-2334
        • Ibáñez-Botella G.
        • Domínguez M.
        • Ros B.
        • De Miguel L.
        • Márquez B.
        • Arráez M.A.
        Endoscopic transchoroidal and transforaminal approaches for resection of third ventricular colloid cysts.
        Neurosurg Rev. 2014; 37: 227-234
        • Iacoangeli M.
        • di Somma L.G.
        • Di Rienzo A.
        • Alvaro L.
        • Nasi D.
        • Scerrati M.
        Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts.
        J Neurosurg. 2014; 120: 1471-1476
        • Tawk R.G.
        • Akinduro O.O.
        • Grewal S.S.
        • Brasiliense L.
        • Grand W.
        • Grotenhuis A.
        Endoscopic transforaminal transchoroidal approach to the third ventricle for cystic and solid tumors.
        World Neurosurg. 2020; 134: e453-e459
        • Tirado-Caballero J.
        • Rivero-Garvía M.
        • González-Pombo M.
        • Cárdenas-Ruiz-Valdepeñas E.
        • Kaen A.
        • Márquez-Rivas J.
        Fully endoscopic transforaminal-transchoroidal approach for tectal area tumor removal.
        World Neurosurg. 2020; 137: 164-172
        • Winkler P.A.
        • Weis S.
        • Büttner A.
        • Raabe A.
        • Amiridze N.
        • Reulen H.J.
        The transcallosal interforniceal approach to the third ventricle: anatomic and microsurgical aspects.
        Neurosurgery. 1997; 40 (981-982): 973-981
        • Gu Y.
        • Hu F.
        • Zhang X.
        Purely endoscopic resection of pineal region tumors using infratentorial supracerebellar approach: how I do it.
        Acta Neurochir. 2016; 158: 2155-2158
        • Cao L.
        • Wu W.
        • Kang J.
        • Qiao H.
        • Yang X.
        • Bai J.
        • et al.
        Expanded transsphenoidal trans-lamina terminalis approach to tumors extending into the third ventricle: technique notes and a single institute experience.
        Front Oncol. 2021; 11
        • Lan Q.
        • Dong J.
        • Huang Q.
        Minimally invasive keyhole approaches for removal of tumors of the third ventricle.
        Chin Med J (Engl). 2006; 119: 1444-1450
        • Iacoangeli M.
        • Colasanti R.
        • Esposito D.
        • Di Rienzo A.
        • di Somma L.
        • Dobran M.
        • et al.
        Supraorbital subfrontal trans-laminar endoscope-assisted approach for tumors of the posterior third ventricle.
        Acta Neurochir. 2017; 159: 645-654
        • Hassaneen W.
        • Suki D.
        • Salaskar A.L.
        • Levine N.B.
        • DeMonte F.
        • Lang F.F.
        • et al.
        Immediate morbidity and mortality associated with transcallosal resection of tumors of the third ventricle.
        J Clin Neurosci. 2010; 17: 830-836
        • Cikla U.
        • Swanson K.I.
        • Tumturk A.
        • Keser N.
        • Uluc K.
        • Cohen-Gadol A.
        • et al.
        Microsurgical resection of tumors of the lateral and third ventricles: operative corridors for difficult-to-reach lesions.
        J Neuro-Oncol. 2016; 130: 331-340
        • Kasowski H.
        • Piepmeier J.M.
        Transcallosal approach for tumors of the lateral and third ventricles.
        Neurosurg Focus. 2001; 10: E3-E5
        • Anderson R.C.E.
        • Ghatan S.
        • Feldstein N.A.
        Surgical approaches to tumors of the lateral ventricle.
        Neurosurg Clin N Am. 2003; 14: 509-525
        • Milligan B.D.
        • Meyer F.B.
        Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience.
        Neurosurgery. 2010; 67 (1496): 1483-1496
        • Aryan H.E.
        • Ozgur B.M.
        • Jandial R.
        • Levy M.L.
        Complications of interhemispheric transcallosal approach in children: Review of 15 years experience.
        Clin Neurol Neurosur. 2006; 108: 790-793
        • Mansour S.
        • Echeverry N.
        • Shapiro S.
        • Snelling B.
        The use of BrainPath tubular retractors in the management of deep brain lesions: a review of current studies.
        World Neurosurg. 2020; 134: 155-163
        • Andrews R.J.
        • Bringas J.R.
        A review of brain retraction and recommendations for minimizing intraoperative brain injury.
        Neurosurgery. 1993; 33 (1063-1064): 1052-1063
        • Okasha M.
        • Ineson G.
        • Pesic-Smith J.
        • Surash S.
        Transcortical approach to deep-seated intraventricular and intra-axial tumors using a tubular retractor system: a technical note and review of the literature.
        J Neurol Surg A: Central Eur Neurosurg. 2021; 82: 270-277
        • Kim M.
        Transcortical Endoscopic Surgery for Intraventricular Lesions.
        J Korean Neurosurg S. 2017; 60: 327-334
        • Grondin R.T.
        • Hader W.
        • MacRae M.E.
        • Hamilton M.G.
        Endoscopic versus microsurgical resection of third ventricle colloid cysts.
        Can J Neurol Sci. 2007; 34: 197-207
        • Sabanci P.A.
        • Aras Y.
        • Ali A.
        • Unal T.C.
        • Dolen D.
        • Sencer S.
        • et al.
        Transcortical removal of third ventricular colloid cysts: a comparison of conventional, guided microsurgical and endoscopic approaches and a review of the literature.
        Turk Neurosurg. 2016;
        • Haider G.
        • Laghari A.A.
        • Shamim M.S.
        Choosing between endoscopic or microscopic removal of third ventricle colloid cysts.
        J Pak Med Assoc. 2017; 67: 1458-1459
        • Gagliardi F.
        • Piloni M.
        • Bailo M.
        • Gragnaniello C.
        • Boari N.
        • Donofrio C.A.
        • et al.
        Anatomic study on neuroendoportal transcortical approach to lateral ventricles.
        World Neurosurg. 2019; 131: e255-e264
        • Capitanio J.F.
        • Donofrio C.A.
        • Panni P.
        • Barzaghi L.R.
        • Bailo M.
        • Gagliardi F.
        • et al.
        Microsurgical endoportal MRI/US-navigated approach for the resection of large intraventricular tumours: a 20-consecutive patients case series.
        Br J Neurosurg. 2021; 35: 570-577
        • Hong C.S.
        • Prevedello D.M.
        • Elder J.B.
        Comparison of endoscope- versus microscope-assisted resection of deep-seated intracranial lesions using a minimally invasive port retractor system.
        J Neurosurg. 2016; 124: 799-810