There are many, many approaches down into this region, and we're gonna go through them step by step. And then if we go through the septum pellucidum up front here, this absolutely incredible beautiful anatomy. So if you look at the relationship of the fornix and the thalamus and the choroid plexus, the reason I like to go lateral to the choroid plexus rather than medial, which is the way it's described in most textbooks is because it gives you one extra cushion to protect this all important fornix. So we see that column of the fornix and we see the body of the fornix. When we look inside the third ventricle, what we really wanna concentrate on is the fornix. Here the internal cerebral veins have been separated and you're looking right down into the third ventricle. We can see the foramen on each side, we see the choroid plexus and I want you to notice the choroid plexus as it sits on the thalamus, because our approach is gonna be a little different than it's usually described from the textbooks. Anatomy, anatomy, anatomy, especially when were talking about the third ventricle, this is a view from above where we can see the two internal cerebral veins. So in order to obviate that we have designed some instruments that really bring light down to us, as you can see right here, by either utilizing a lighted suction or a lighted bipolar. And that can vary between three to six degrees, depending on how long your focal length is, which means that if you wanna have the best vision, which is straight down the visual axis, your light may be totally inadequate because it'll bounce off the side and this is particularly so as we work with very increasingly smaller corridors. One of the things that's really important is to recognize is that our visual axis and our light axis come in at different angles. And this is basically the way we sit at the operating room table. And with a foot pedal, you can obviously use the mouthpiece in an arc motion rather than just the X, Y axis. And the mouthpiece also always gives you the very best trajectory for your vision and for your light. There are many different ways to be in the comfort zone, for me to be sitting, having arm rests and wrist support, and then utilizing your foot pedals, like playing an organ, to move the microscope if necessary, always using a mouthpiece so that your hands are constantly available. In order to really do microsurgery as is required for this particularly difficult area, the surgeon needs to be comfortable. And that really requires everything that we know how to get to the deep portions of the brain. It's a pleasure to be talking about a kind of lesion that really requires everything that we have learned about the anatomy. Spetzler, thank you again for being such an immense contributor to this series and please go ahead. And that's an indication for really the difficulty of this location. And they're more approaches described to the third ventricle than any other place in the brain. And really one of the most difficult places to reach. He's gonna talk to us about the third ventricular tumors or lesions in the area, a place many of us refer to as the seat of the soul, if such a thing exists as the seat of the soul per se. He doesn't require any introduction, truly a role model for me and all of us. Robert Spetzler from Barrow Neurological Institute.
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