Endoscopic Transchoroidal Fissure Approach to the Posterior Third Ventricle

Third ventricle lesions present a challenge of modern neurosurgery. Tubular retractors, inserted transcortically transventricularly from post-Kocher point in direction to foramen Monro, enable in combination with endoscopic visualization and illumination sufficient surgical exposure of area posterior to formen Monro and permit 2-hand surgery and use of microsurgical technique. Transchoroidal fissure splitting through a tubular retractor expands the foramen of Monro posteriorly from the ETV trajectory over and behind adhesio interthalamica to the posterior third ventricle’s roof and floor, suprapineal and the tectal area. In pineal tumors extending into the posterior third ventricle, it is possible to enter the posterior third ventricle by an endoscopic supracerebellar-infratentorial approach via transvenous-suprapineal corridor.