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Beger O, Alpergin BC, Zaimoglu M, Orhan O, Kılınç MC, Unal S, Eray HA, Eroglu U. Massa intermedia in adults: incidence, dimension, location and clinical importance. Surg Radiol Anat 2024; 46:137-152. [PMID: 38191743 DOI: 10.1007/s00276-023-03274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE This retrospective magnetic resonance imaging investigation aimed to obtain information related to the anatomy of the massa intermedia (MI) in an adult population. METHODS The work conducted on MRI views of 1058 (539 males and 519 females) healthy adult samples aged with 48.93 ± 17.63 years. Initially, the presence or absence of MI was noted, and then if present, its numbers and location in the third ventricle were recorded. Its horizontal (HDMI) and vertical (VDMI) diameters were measured on MRI views, while the cross-sectional area (CSAMI) was calculated using its diameters. RESULTS MI was missing in 2.6% (27 cases) of 1058 adult samples. Six subjects (0.6%) had a double MI. HDMI, VDMI and CSAMI were measured as 4.83 ± 1.01 mm, 4.86 ± 0.98 mm, and 19.11 ± 7.23 mm2, respectively. MI size did not show a significant alteration from 19 up to 49 years, but then its size distinctly decreased between 50 and 60 years. After age 60, MI dimension did not display an important change. MI was settled in the antero-superior quadrant in 929 cases (90.63% of 1025 subjects), in the postero-superior quadrant in 22 cases (2.15%), in the antero-inferior quadrant in 32 cases (3.12%), in the postero-inferior quadrant in 8 cases (0.78%), and in the central part in 34 cases (3.32%). CONCLUSIONS The size, position and incidence of MI were not affected by sex, and its position and incidence were not affected by adult age periods. In adults, MI size demonstrated a significant decrease in the middle age.
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Affiliation(s)
- Orhan Beger
- Faculty of Medicine, Department of Anatomy, Gaziantep University, Gaziantep, 27310, Turkey.
| | - Baran Can Alpergin
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Murat Zaimoglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Ozgur Orhan
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Mustafa Cemil Kılınç
- Çorum Erol Olçok Training and Research Hospital, Department of Neurosurgery, Hitit University, Çorum, Turkey
| | - Sena Unal
- Faculty of Medicine, Department of Radiology, Ankara University, Ankara, Turkey
| | - Halit Anil Eray
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
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Kılınç MC, Alpergin BC, Mete EB, Eroglu U, Beger O. Anatomic Features of the Interthalamic Adhesion in the Pediatric Population. World Neurosurg 2023; 180:e631-e643. [PMID: 37806519 DOI: 10.1016/j.wneu.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The main goal of this retrospective study was to examine the morphology of the interthalamic adhesion (ITA) in normal children aged between 1 and 18 years. METHODS The study universe consisted of magnetic resonance images of 180 healthy pediatric subjects (age, 9.50 ± 5.20 years, sex, 90 girls and 90 boys). The cross-sectional area (CSA), vertical diameter (VD), and horizontal diameter (HD) of the ITA were measured and in addition, its location was noted. RESULTS HD, VD, and CSA of the ITA were measured as 8.47 ± 1.64 mm, 7.59 ± 1.57 mm, and 52.06 ± 18.51 mm2, respectively. HD did not change from infancy until postpubescence, but then significantly decreased (P < 0.001). VD increased up to early childhood but then did not alter until the end of prepubescence. After that period, it decreased in postpubescence (P < 0.001). CSA tended to decrease in an irregular pattern according to pediatric age periods (P < 0.001). The ITA was located at the anterosuperior quadrant in 138 individuals (76.70%), at the anteroinferior quadrant in 7 individuals (3.90%), and the center of the lateral wall of the third ventricle in 35 individuals (19.40%). Linear functions were calculated as y = 9.490-0.107 × age (years) for HD, y = 8.453-0.091 × age (years) for VD, and y = 63.559-1.211 × age (years) for CSA. CONCLUSIONS ITA size irregularly decreases with advancing age from 1 to 18 years. Our calculated linear functions, showing the growth dynamics of the ITA by pediatric ages, may be helpful in estimating its dimension.
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Affiliation(s)
- Mustafa Cemil Kılınç
- Department of Neurosurgery, Çorum Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Baran Can Alpergin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emre Bahir Mete
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
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Paolini S, Severino R, Ciavarro M, Missori P, Cardarelli G, Mancarella C. Balloon-Assisted Corpus Callosotomy. Reducing the Impact of Transcallosal Approaches. Oper Neurosurg (Hagerstown) 2023; 24:e155-e159. [PMID: 36701680 DOI: 10.1227/ons.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/12/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The interhemispheric transcallosal approach is widely used to remove intraventricular lesions. Corpus callosotomy gives immediate access to the ventricular chambers but is invasive in nature. Loss of callosal fibers, although normally tolerate, may cause disturbances ranging from a classical disconnection syndrome up to minor neuropsychological changes. OBJECTIVE To open an operative window in the corpus callosum through separation rather than disconnection of the white matter fibers. METHODS In 7 patients undergoing the interhemispheric transcallosal approach for intraventricular lesions, lying around or below the foramen of Monro, a stoma was created within the corpus callosum by using a 4F Fogarty catheter. The series included 3 colloid of the third ventricle, 2 thalamic cavernomas, 1 subependymoma, and 1 ependymoma of the foramen of Monro. We illustrate the technique and the clinico-radiological outcome, focusing on the size of callosotomy as seen on postoperative MRI. RESULTS The balloon-assisted corpus callosotomy provided a circular, smooth-walled access to the ventricular chambers, which allowed uncomplicated removal of the lesions. On postoperative MRI, the size of the callosotomy shrinked compared with surgery (2.8-6.4 mm at follow-up vs 6-9 mm as measured intraoperatively). No signs of disconnection syndrome or new permanent deficits were observed in this series. CONCLUSION The balloon-assisted technique produces a small callosotomy, without clinical consequences, showing a self-closing trend on postoperative MRI. This technique is a rewarding tool to reduce the impact of callosotomy while keeping the advantages of microsurgical interhemispheric approaches.
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Affiliation(s)
- Sergio Paolini
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Rocco Severino
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Marco Ciavarro
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Giovanni Cardarelli
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Cristina Mancarella
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
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Gungor A, Gurses ME, Dogan E, Varol E, Gökalp E, Etli MU, Ozoner B. Interhemispheric Transcingulate Sulcus Approach to Deep-Seated Medial Frontal and Parietal Lesions-Fiber Dissection Study With Illustrative Cases. Oper Neurosurg (Hagerstown) 2023; 24:e178-e186. [PMID: 36701601 DOI: 10.1227/ons.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/02/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgery for lesions located in the medial frontal and parietal lobes can be quite challenging for neurosurgeons because of morbidities that may arise from damage to critical midline structures or intact neural tissue that need to be crossed to reach the lesion. In our anatomic studies, the cingulate sulcus was observed as an alternative access route for lesions located in medial frontal and parietal lobes. OBJECTIVE To explain the microsurgical anatomy of the medial hemisphere and cingulate sulcus and to demonstrate the interhemispheric transcingulate sulcus approach (ITCSA) with 3 clinical cases. METHODS Five formalin-fixed brain specimens, which were frozen at -18 °C for at least 2 weeks and then thawed under tap water, were gradually dissected from medial to lateral. Diffusion fiber tracking performed using DSI Studio software in data was provided by the Human Connectome Project. Clinical data of 3 patients who underwent ITCSA were reviewed. RESULTS Cingulate sulcus is an effortlessly identifiable continuous sulcus on the medial surface of the brain. Our anatomic dissection study revealed that the lesions located in the deep medial frontal and parietal lobes can be reached through the cingulate sulcus with minor injury only to the cingulum and callosal fibers. Three patients were treated with ITCSA without any neurological morbidity. CONCLUSION Deep-seated lesions in the medial frontal lobe and parietal lobe medial to the corona radiata can be approached by using microsurgical techniques based on anatomic information. ITCSA offers an alternative route to these lesions besides the known lateral transcortical/transsulcal and interhemispheric transcingulate gyrus approaches.
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Affiliation(s)
- Abuzer Gungor
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Muhammet Enes Gurses
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
- Department of Neurosurgery, Hacettepe University, Ankara, Turkey
| | - Eray Dogan
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Eyup Varol
- Department of Neurosurgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Elif Gökalp
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Mustafa Umut Etli
- Department of Neurosurgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Baris Ozoner
- Department of Neurosurgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
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Sakata K, Hashimoto A, Kotaki Y, Yoshitake H, Shimokawa S, Komaki S, Nakamura H, Furuta T, Morioka M. Successful Treatment of Pure Aqueductal Pilomyxoid Astrocytoma and Arrested Hydrocephalus With Endoscopic Tumor Resection Followed by Chemotherapy: A Case Report and Technical Considerations. NEUROSURGERY OPEN 2023. [DOI: 10.1227/neuprac.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Keleş A, Türe U. Cottonoid-guided intraoperative ultrasonography in neurosurgery: a proof-of-concept single surgeon case series. Neurosurg Rev 2022; 45:2289-2303. [PMID: 35112223 DOI: 10.1007/s10143-021-01727-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Abstract
Ultrasonography was introduced into neurosurgery in the 1950s, but its successful utilization as an intraoperative tool dates from the early 1980s. However, it was not used widely because of limited technology, a lack of specific training, and, most importantly, the concurrent evolution of computerized tomography and magnetic resonance imaging. The intraoperative use of cottonoid patties as acoustical markers was first described in 1984, but the practice did not gain acceptance, and no articles have been published since. Herein, we reconsider the echogenic properties of the surgical cottonoid patty and demonstrate its usefulness with intraoperative ultrasonography (ioUS) in neurosurgical practice as a truly real-time neuronavigation tool. We also discuss its advantages and compare it with other intraoperative image guidance tools. The echogenic properties of the handmade cottonoid patties in various sizes used with ioUS are described. Details of our cottonoid-guided ioUS technique and its advantages with illustrated cases are also described. As an echogenic marker, cottonoid patties can be easily recognized with ioUS. Their usage with ultrasonography provides truly real-time anatomical orientation throughout the surgery, allowing easy access to intraparenchymal pathologies, and precise and safer resection. Cottonoid-guided ioUS helps not only to localize intraparenchymal pathologies but also to delineate the exact surgical trajectory for each type of lesion. Furthermore, it is not affected by brain shift and distortion. Thus, it is a truly real-time, dynamic, cost-effective, and easy-to-use image guidance tool. This technique can be used safely for every intraparenchymal pathology and increases the accuracy and safety of the surgeries.
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Affiliation(s)
- Abdullah Keleş
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Uğur Türe
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
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