{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:57:13Z","timestamp":1786125433757,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2020,3,4]],"date-time":"2020-03-04T00:00:00Z","timestamp":1583280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2020,8]]},"abstract":"Abstract<\/jats:title>\n \n BACKGROUND<\/jats:title>\n Pineal region tumors are associated with the ventricular system. Endoscopic third ventriculostomy (ETV) is often performed at the same time as tumor biopsy.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n To investigate the volume of brain possibly undergoing injury and forniceal stretching during ETV and tumor biopsy.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We performed a retrospective review of preoperative magnetic resonance imagings (MRIs) and computed tomography (CTs) of patients with pineal region masses and used volumetric image-guided navigation to simulate a 1-burr-hole vs a 2-burr-hole approach through the brain parenchyma. We compared the volumes of parenchyma and fornix at the risk of injury.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The ideal entry point for ETV using 2 burr holes was a mean\u00a0\u00b1\u00a0standard deviation (SD) of 25.8\u00a0\u00b1\u00a06 mm from the midline and 11.4\u00a0\u00b1\u00a09 mm behind the coronal suture. The ideal entry point using 2 burr holes for tumor biopsy was 25.7\u00a0\u00b1\u00a08 mm from the midline and 53.7\u00a0\u00b1\u00a014 mm anterior to the coronal suture. With 1 burr hole, the mean\u00a0\u00b1\u00a0SD volume of brain parenchyma at risk was 852\u00a0\u00b1\u00a0440 mm\n 3<\/jats:sup>\n . The volume of brain parenchyma at risk with 2 burr holes was 2159\u00a0\u00b1\u00a0474 mm\n 3<\/jats:sup>\n (\n P<\/jats:italic>\n \u00a0<\u00a0.001; paired\n t<\/jats:italic>\n -test). The use of 1 burr hole predisposed the fornix to 14\u00a0\u00b1\u00a03 mm of possible stretch, which was minimized with the 2-burr-hole approach.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n Using 1 burr hole for both the ETV and tumor biopsy is less likely to traumatize the brain parenchyma than using 2 burr holes. However, 1 burr hole predisposes the fornix to stretch injury. We recommend tailoring the entry to each patient according to their anatomy rather than using a 1-size-fits-all approach.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ons\/opaa010","type":"journal-article","created":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T02:30:18Z","timestamp":1583375418000},"page":"175-180","source":"Crossref","is-referenced-by-count":9,"title":["One- vs Two-Burr-Hole Technique for Combined Endoscopic Third Ventriculostomy and Pineal Region Biopsy: Volumetric Analysis of Brain at Risk"],"prefix":"10.1227","volume":"19","author":[{"given":"Brandon D","family":"Liebelt","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangxiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Biroli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nakaji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,8]]},"reference":[{"key":"bib1-20231031","first-page":"357","article-title":"Management of 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