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Fluorescein-Enhanced Characterization of Additional Anatomical Landmarks in Cerebral Ventricular Endoscopy

Longatti, Pierluigi MD; Basaldella, Luca MD; Sammartino, Francesco MD; Boaro, Alessandro MD; Fiorindi, Alessandro MD, PhD

doi: 10.1227/NEU.0b013e3182889e27
Concepts, Innovations, and Techniques

BACKGROUND: Fluorescein enhancement to detect retinal disorder or differentiate cancer tissue in situ is a well-defined diagnostic procedure. It is a visible marker of where the blood-brain barrier is absent or disrupted. Little is reported in the contemporary literature on endoscopic fluorescein-enhanced visualization of the circumventricular organs, and the relevance of these structures as additional markers for safe ventricular endoscopic navigation remains an unexplored field.

OBJECTIVE: To describe fluorescein sodium–enhanced visualization of circumventricular organs as additional anatomic landmarks during endoscopic ventricular surgery procedures.

METHODS: We prospectively administered intravenously 500 mg fluorescein sodium in 12 consecutive endoscopic surgery patients. A flexible endoscope equipped with dual observation modes for both white light and fluorescence was used. During navigation from the lateral to the fourth ventricle, the endoscopic anatomic landmarks were first inspected under white light and then under the fluorescent mode.

RESULTS: After a mean of 20 seconds in the fluorescent mode, the fluorescein enhanced visualization of the choroid plexus of the lateral ventricle, median eminence–tuber cinereum complex, organum vasculosum of the lamina terminalis, choroid plexus of the third and fourth ventricles, and area postrema.

CONCLUSION: Fluorescein-enhanced visualization is a useful tool for helping neuroendoscopists recognize endoscopic anatomic landmarks. It could be adopted to guide orientation when the surgeon deems an endoscopic procedure unsafe or contraindicated because of unclear or subverted anatomic landmarks. Visualization of the circumventricular organs could add new insight into the functional anatomy of these structures, with possible implications for the site and safety of third ventriculostomy.

ABBREVIATIONS: AP, area postrema

BBB, blood-brain barrier

CVO, circumventricular organ

ETV, endoscopic third ventriculostomy

ME, median eminence

OVLT, organum vasculosum lamina terminalis

Department of Neurosurgery, Treviso Regional Hospital, University of Padova, Treviso, Italy

Correspondence: Luca Basaldella, MD, Department of Neurosurgery, Treviso Regional Hospital, University of Padova, Pzza.le Ospedale Civile 1, 31100 Treviso, Italy. E-mail:

Received August 08, 2012

Accepted January 04, 2013

Copyright © by the Congress of Neurological Surgeons