Optimal surgical approaches to the third ventricle: A comprehensive assessment

The third ventricle, a narrow midline cavity between the thalami, represents one of the most challenging regions for neurosurgery to approach micro-surgically. Since the earliest descriptions of surgical corridors to this area, numerous approaches have been developed, yet optimal management remains debated. The choice of surgical route is influenced by lesion location, differential diagnosis, size, patient clinical status, and the surgeon’s familiarity with specific anatomical corridors. In this review, we broaden the discussion by not only outlining the nine principal microsurgical approaches to third ventricle lesions but also by comparing their indication. contraindication, pitfalls, and technical considerations based on prior literature to contextualize current strategies and highlight evolving trends in patient selection. By integrating anatomical schematics with comparisons, this review aims to provide a practical framework for tailoring third ventricle surgery to individual patients.