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Neurosurgery. 74(4):426-436, April 2014
The endoscope is advanced in a standard approach to the lateral horn and through the foramen of Monro into the third ventricle. The mammillary bodies are visualized; under the massa intermedia the endoscope is oriented posteriorly until the cerebral aqueduct is found. Once at the cerebral aqueduct entrance, the flexible endoscope is rotated clockwise until the fourth ventricle is entered. The choroid plexus is observed at the roof of the fourth ventricle and followed laterally to reach for the foramen of Luschka. The endoscope is passed underneath the inferior cerebellar peduncle. A thin membranous veil covers the Lushcka foramina, in this case the membrane is abnormally thickened. A blunt instrument is used to perforate the membrane and create an opening that is widened by moving the endoscope laterally. Caution should be used to avoid injury to the cranial nerves. The endoscope is drawn back to the midline of the fourth ventricle until the Magendie foramina is identified. Similarly, a blunt instrument is used to open the Magendie foramina. Caution should also be used to avoid injury to the posteroinferior cerebellar arteries. The endoscope is advanced through the foramen magnum into the cisterna magna. Lastly, the endoscopes is carefully withdrawn out of the ventricles.
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