Simulation of endoscopic third ventriculostomy in fresh cadaveric specimens.

Objective: The purpose of this research is to describe and analyze the endoscopic anatomy of cerebral ventricles, especially of the lateral ventricle and third ventricle.

Methods: 47 brains of adult human cadavers were studied at the Death Check Unit (DCU) of São Paulo. Age, sex, day and approximate time of death, day and time of study, cause of death, outcome of puncture and number of attempts were recorded. A rigid neuroendoscope was utilized. The approach to the ventricular system was via the pre-coronal point on the right side.

Results: The number of individuals studied was 47, of which 22 (47%) were women and 25 (53%) were men. Age ranged from 20 to 95 years. The minimum time lag between the death and the study was 8 h and the maximum time was 29 h. Of the cadavers studied, three presented alterations in the central nervous system as the cause of death. Successful puncture was obtained in 42 (89%) being 72% in the first attempt. In the analysis performed by Fisher's exact test with a 5% level of significance, an association between the number of attempts (2) and the cause of cerebral death was found (p=0.018).

Conclusions: The visualization of neural structures without bleeding, the possibility of training techniques such as third ventriculostomy, the development of new techniques and to help sctructure new concepts about anatomic landmarks have by far overcome the difficulties.