• Pasqualino Ciappetta, Maria Pia Tropeano, Lorenzo Gitto, and Lorenzo Pescatori.
• Department of Neurosciences, Section of Neurosurgery, University of Bari Medical School, Bari, Italy.
• World Neurosurg. 2019 Aug 1; 128: e116-e128.

BackgroundThe fornix is a region of greatest neurosurgical interest in regards to its complex anatomy and surgical approaches to this area. The objective of this study was to evaluate the morphology of the triangular recess (TR) and its role in the growth pattern of the colloid cysts (CC) within the third ventricle and in the choice of the surgical approach for their removal. Furthermore, to compare the results of the dissections with measurements performed on a magnetic resonance imaging scan.MethodsIn the anatomic study, 20 cadaveric specimens were dissected and analyzed. In the radiologic study, a magnetic resonance imaging scan was performed in 20 healthy volunteers. In the clinical study, a retrospective analysis of all the patients affected with CCs microsurgically removed at our institute between 2010 and 2018 was conducted.ResultsIn the anatomic study, the width, height, and the area of the TR were respectively 0.31 cm, 0.33cm, and 0.051 cm2. In the radiologic study, 3 different typologies of TR were identified: open recess in ventriculomegaly (7 patients); open recess in physiologic ventricular system (3 patients); closed or blind recess (10 patients). Three different growth patterns of CCs were identified: type 1) CCs localized at the foramen of Monro growing behind the fornix and below the third ventricular roof; type 2) CCs growing rostrally between the column of fornix; and type 3) CCs growing above the plane of the third ventricular roof.ConclusionsThe anatomy of the TR influences the growth pattern of CC within the ventricular cavity and determines the surgical strategy for their removal.Copyright © 2019 Elsevier Inc. All rights reserved.

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