Christos Koutsarnakis1, Faidon Liakos2, Aristotelis V Kalyvas3, Georgios P Skandalakis4, Spyros Komaitis3, Fotini Christidi5, Efstratios Karavasilis6, Evangelia Liouta7, George Stranjalis3. 1. Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Clinical Neuroscience, Western General Hospital, Edinburgh, United Kingdom. Electronic address: ckouts@hotmail.co.uk. 2. Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece. 3. Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, Athens, Greece. 4. Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; School of Medicine, University of Athens, Athens, Greece. 5. 2nd Department of Radiology, School of Medicine, University of Athens, Athens, Greece. 6. Department of Neurology, Aeginition Hospital, University of Athens, Athens, Greece. 7. Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece.
Abstract
OBJECTIVE: To explore the superior frontal sulcus (SFS) morphology, trajectory of the applied surgical corridor, and white matter bundles that are traversed during the superior frontal transsulcal transventricular approach. METHODS: Twenty normal, adult, formalin-fixed cerebral hemispheres and 2 cadaveric heads were included in the study. The topography, morphology, and dimensions of the SFS were recorded in all specimens. Fourteen hemispheres were investigated through the fiber dissection technique whereas the remaining 6 were explored using coronal cuts. The cadaveric heads were used to perform the superior frontal transsulcal transventricular approach. In addition, 2 healthy volunteers underwent diffusion tensor imaging and tractography reconstruction studies. RESULTS: The SFS was interrupted in 40% of the specimens studied and was always parallel to the interhemispheric fissure. The proximal 5 cm of the SFS (starting from the SFS precentral sulcus meeting point) were found to overlie the anterior ventricular system in all hemispheres. Five discrete white matter layers were identified en route to the anterior ventricular system (i.e., the arcuate fibers, the frontal aslant tract, the external capsule, internal capsule, and the callosal radiations). Diffusion tensor imaging studies confirmed the fiber tract architecture. CONCLUSIONS: When feasible, the superior frontal transsulcal transventricular approach offers a safe and effective corridor to the anterior part of the lateral ventricle because it minimizes brain retraction and transgression and offers a wide and straightforward working corridor. Meticulous preoperative planning coupled with a sound microneurosurgical technique are prerequisites to perform the approach successfully.
OBJECTIVE: To explore the superior frontal sulcus (SFS) morphology, trajectory of the applied surgical corridor, and white matter bundles that are traversed during the superior frontal transsulcal transventricular approach. METHODS: Twenty normal, adult, formalin-fixed cerebral hemispheres and 2 cadaveric heads were included in the study. The topography, morphology, and dimensions of the SFS were recorded in all specimens. Fourteen hemispheres were investigated through the fiber dissection technique whereas the remaining 6 were explored using coronal cuts. The cadaveric heads were used to perform the superior frontal transsulcal transventricular approach. In addition, 2 healthy volunteers underwent diffusion tensor imaging and tractography reconstruction studies. RESULTS: The SFS was interrupted in 40% of the specimens studied and was always parallel to the interhemispheric fissure. The proximal 5 cm of the SFS (starting from the SFS precentral sulcus meeting point) were found to overlie the anterior ventricular system in all hemispheres. Five discrete white matter layers were identified en route to the anterior ventricular system (i.e., the arcuate fibers, the frontal aslant tract, the external capsule, internal capsule, and the callosal radiations). Diffusion tensor imaging studies confirmed the fiber tract architecture. CONCLUSIONS: When feasible, the superior frontal transsulcal transventricular approach offers a safe and effective corridor to the anterior part of the lateral ventricle because it minimizes brain retraction and transgression and offers a wide and straightforward working corridor. Meticulous preoperative planning coupled with a sound microneurosurgical technique are prerequisites to perform the approach successfully.
Authors: Benjamin L Chernoff; Max H Sims; Susan O Smith; Webster H Pilcher; Bradford Z Mahon Journal: Cogn Neuropsychol Date: 2019-06-18 Impact factor: 2.468
Authors: Emanuele La Corte; Daniela Eldahaby; Elena Greco; Domenico Aquino; Giacomo Bertolini; Vincenzo Levi; Malte Ottenhausen; Greta Demichelis; Luigi Michele Romito; Francesco Acerbi; Morgan Broggi; Marco Paolo Schiariti; Paolo Ferroli; Maria Grazia Bruzzone; Graziano Serrao Journal: Front Neurol Date: 2021-02-24 Impact factor: 4.003