Contralateral anterior interhemispheric-transcallosal-transrostral approach to the subcallosal region: a novel surgical technique (original) (raw)
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Operative Neurosurgery
BACKGROUND: Suprachiasmatic subcallosal lesions may have an intimate relationship with the anterior communicating artery (AcomA); injury to AcomA branches can result in basal forebrain infarction and cognitive dysfunction. OBJECTIVE: To evaluate anatomic variations of the AcomA basal perforating branches, especially the subcallosal artery (ScA), for clinical implications when approaching the suprachiasmatic subcallosal region from endonasal and transcranial routes. METHODS: The origin, course, diameter, and branching pattern of the AcomA's perforating branches were studied in 33 specimens from transcranial and endonasal perspectives. RESULTS: The ScA was present in 79% of the specimens as a single dominant artery arising from the posterior/posterosuperior surface of the AcomA, along with hypothalamic arteries (55%), or as a single artery (24%). It coursed posteriorly towards the lamina terminalis region, curving superiorly to the subcallosal area. The ScA gave off many branches to provide the main blood supply to the subcallosal region. Importantly, it supplies the septal/subcallosal region bilaterally. The ScA can be found posterior, superior, or inferior to the AcomA when using a transylvian, interhemispheric, or endonasal approach, respectively. In specimens with no ScA (21%), the median callosal artery (MdCA) was the dominant artery arising from the AcomA. It followed an identical course to the ScA, providing supply to the same structures bilaterally, but its distal extension reached the body/splenium of the corpus callosum. The MdCA is a ScA variant. CONCLUSION: The ScA is a unique vessel because it supplies the septal/subcallosal region bilaterally; preservation of this vessel during surgery is crucial for successful outcomes.
Anatomic basis for surgical approach to the distal segment of the posterior cerebral artery
Surgical and Radiologic Anatomy, 1988
The distal segment of the posterior cerebral artery (PCA), which extends from the junction with the posterior communicating artery to its terminal division into the parieto-occipital and calcarine arteries, was examined in 37 brains. Three types of distal segment were distinguished. lri the first type (42.9 %), the terminal division was located either in the calcarine sulcus or in the quadrigeminal cistern. In the second type (41.4 %), the terminal division had the same position, but the distal segment, in addition to its terminal stems, also gave off the common temporal artery, In the third type (15.7 %), the terminal division was seen in the ambient cistern. The distal segment of the PCA gave rise to several collateral branches : the collicular artery (2.8 %), the anterior (28.6 %L middle (30.0 %), and posterior (28.6 %) hippocampal arteries, the proximal (82.9 %) and distal (20.0 %) lateral posterior choroidal arteries, the proximal (40.0 %) and distal (41.4 %) medial posterior choroidal arteries, the peduncular, thalamogeniculate and splenial branches, the lingual gyri artery and the temporal arteries. Several anatomic variants of the distal segment were observed in this study: fenestration of the distal segment (1.4 %), location of the distal. segment dorsal to the uncus (2.8 %), origin of the collicular (2.8 %) and anterior choroidal arteries (1.4 %) from the distal segment, and protrusion of the parieto-occipital arterial loop into the lateral ventricle (2.8 %). The authors discuss the clinical significance of these anatomic data.
Microsurgical anatomy of the distal anterior cerebral artery
Journal of Neurosurgery, 1978
✓ The microsurgical anatomy of the distal anterior cerebral artery (ACA) has been defined in 50 cerebral hemispheres. The distal ACA, the portion beginning at the anterior communicating artery (ACoA), was divided into four segments (A2 through A5) according to Fischer. The distal ACA gave origin to central and cerebral branches. The central branches passed to the optic chiasm, suprachiasmatic area, and anterior forebrain below the corpus callosum. The cerebral branches were divided into cortical, subcortical, and callosal branches. The most frequent site of origin of the cortical branches was as follows: orbitofrontal and frontopolar arteries, A2; the anterior and middle internal frontal and callosomarginal arteries, A3; the paracentral artery, A4; and the superior and inferior parietal arteries, A5. The posterior internal frontal artery arose with approximately equal frequency from A3 and A4 and the callosomarginal artery. All the cortical branches arose more frequently from the pe...
S urgical treatment of complex middle cerebral artery (MCA) aneurysms is challenging because aneurysm obliteration is technically demanding and often requires revascularization of the distal MCA territory. Extracranial (EC)-intracranial (IC) bypass techniques are commonly used for this purpose, 14,18,20,22,29,30 but IC-IC bypass techniques are gaining attention as they offer matched donor-recipient arterial calibers, spare the patient from multiple incisions, and require fewer suture lines, which may increase bypass patency. 2,17,26,31 Four main techniques of IC-IC bypass are typically used to treat complex MCA aneurysms: 1) reanastomosis, which involves using the parent artery as the donor; 2) interpositional bypass, which uses a graft vessel between another donor artery and the recipient; 3) in situ anastomosis, which connects 2 parallel arteries that are close to each other; and 4) reimplantation, which connects the recipient artery to the side of the parent artery. 31 Each of these bypass techniques carries its own requirements and risks, 26,31 including the risk to the vascular territory of the donor artery during the bypass procedure, which is a disadvantage of all IC-IC bypasses. The anterior temporal artery (ATA) is an intracranial artery whose occlusion does not cause significant clinical neurological deficit, an uncommon feature of the intracra-ABBREVIATIONS AA = angular artery; AP = anterior parietal; ATA = anterior temporal artery; CA = central artery; EC = extracranial; IC = intracranial; MCA = middle cerebral artery; MT = middle temporal; OF = orbitofrontal
Neuropsychological assessment of the transcallosal approach
European Archives of Psychiatry and Neurological Sciences, 1988
The long-term consequences of partial callosal lesions were examined in 7 neurosurgically treated patients Detailed clinical and neuropsychological assessment of the interhemispheric transfer (multimodal sensory and motor tasks) as well as memory and attention tests were used The results revealed some disconnection symptoms with minor clinical significance, which could not be attributed to particular sites of the corpus callosum, except the splenium It is questionable whether the reported memory and attention impairments are caused by the callosal lesion or by extracallosal pathology The results indicate that the transcallosal approach is a safe and feasible alternative in the management of pathological midline processes in the brain.
min - Minimally Invasive Neurosurgery, 2009
reveals that the temporomesial area can e! ectively be exposed from the anterior subfrontal direction. Compared with the subtemporal, transtemporal and pterional-transsylvian approaches, the subfrontal route o! ers optimal exposure of the anterio-superior temporomesial structures without transcortical access and without the necessity to open the Sylvian ssure (! " Fig. 1). Thus, intracranial lesions located within the anterio-superior mesial part of the temporal lobe may su" ciently be approached through a subfrontal supraorbital craniotomy, without retraction and injury of the frontotemporal operculum and temporal cortex.
Neurosurgical Review, 2020
The operative approach to the posterior incisural space is challenging because of its deep location, the surrounding eloquent areas, and the intimate relationship with the deep veins. Several approaches have been proposed to manage the lesions in this region: supratentorial, infratentorial and a combination of them. Brain retraction, injury to the occipital lobe and corpus callosum, and venous bleeding are the principle drawbacks of these routes. We performed anatomical dissection study using 10 embalmed human cadaver specimens injected with colored latex exploring a different route, parietal interhemispheric transfalcine transtentorial (PITT). Then we used a PITT approach on two patients with posterior incisural space (PIS) lesions. The PITT approach led to successful and safe complete removal of PIS lesions in our cases. No complications were reported. The present approach could be a valuable option in case of PIS lesions, especially those associated with downward displacement of the deep venous complex; thanks to the gravity it reduce the complications related to the occipital lobe retraction and manipulation. Moreover, cutting the superior-anterior edge of the tentorium, the sub-tentorial space could be reached.