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غرفة التنظير الداخليEndoscopy suite

Ventricular neuroendoscopy

The route of an endoscopic third ventriculostomy: a rigid scope enters the right frontal horn through a burr hole at Kocher's point, finds the foramen of Monro where the veins and the choroid plexus converge, passes through it into the third ventricle and stands over the thin floor, where a stoma between the mammillary bodies and the infundibular recess lets the fluid of an obstructed (hydrocephalic) ventricle drain to the cisterns below.

  • Bronchoscopy
  • Gastroscopy
  • Colonoscopy
  • Cystoscopy
  • Ventriculoscopy

Scope view

Preparing the organ…

Tip 0° up, 0° rightShaft turned 0°

↑ ↓ or scroll: advance and withdraw · drag or W A S D: bend the tip · Q E: turn the scope · Enter: go into the chosen orifice

Picture orientation

The picture is what the neuroendoscope sees, its up mark at 12 o'clock as the surgeon holds it. A rigid scope does not bend: it is aimed by moving the whole scope, which the tip controls stand in for over a small range.

The letters on the rim follow the scope as it turns: A anterior, P posterior, R and L the patient's right and left, S and I superior (toward the head) and inferior. An axis shows only while it lies across the picture; one running along the view fades out.

Map

Seen from the patient's right side, the front on your right.

You are in

Labels are off: nothing in the picture is named, the breadcrumb is hidden and the map shows no scope until you find it.

Anatomy: BodyParts3D, © DBCLS, CC BY-SA 2.1 Japan — the lumen, its centreline and its landmarks built for this trainer. The lighting, the mucosa and its patterns are drawn, not photographed. Also drawn rather than measured:

  • The ventricles are enlarged as in obstructive hydrocephalus, the condition an endoscopic third ventriculostomy treats: BodyParts3D's are a normal adult's, so every wall is moved 2.5 mm outward (the lateral ventricle's 5 mm) and the foramen of Monro is opened to about 9 mm across.
  • The aqueduct is widened by only 1 mm, as in the aqueductal stenosis that is the usual reason for the operation.
  • The interthalamic adhesion is BodyParts3D's cross-section, carried across the widened third ventricle.
  • The mammillary bodies are two mounds drawn on the floor where BodyParts3D places them.
  • The choroid plexus is drawn as a slender ridge of fine lobules along the course of BodyParts3D's plexus, and on in through the back of the foramen.
  • The thalamostriate and septal veins are painted along their usual courses to the venous angle at the back of the foramen.
  • The thin grey tuber cinereum, the shadow of the basilar artery's tip beneath it (BodyParts3D's basilar artery) and the red flush of the infundibular recess are painted.
  • Only the right lateral ventricle in front of the atrium is modelled; the septum pellucidum is a flat wall on the midline.
  • The scope enters on Kocher's line, but its last 15 mm into the foramen turn about 30° off it: in this model the caudate nucleus stands over the foramen's outer side.