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Muhammad S, Zhang R, Filler T, Hänggi D, Meling TR. Trans-lateral ventricular approach for surgical treatment of high-located P2-P3 junction posterior cerebral artery aneurysms: from anatomical research to clinical application. Acta Neurochir (Wien) 2024; 166:50. [PMID: 38289511 PMCID: PMC10828004 DOI: 10.1007/s00701-024-05942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/24/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Posterior cerebral artery (PCA) aneurysms, though rare, pose treatment challenges. Endovascular therapy is the preferred option, but microsurgery becomes necessary in certain cases. Various microsurgical approaches have been suggested for PCA aneurysms, particularly those at the P2-P3 junction. This study highlights the trans-lateral ventricular approach (TVA) for addressing these complex aneurysms. This study aims to assess the feasibility and safety of the trans-lateral ventricular approach (TVA) for treating high-located complex PCA aneurysms at the P2-P3 junction. The study evaluates both clinical outcomes and anatomical considerations. METHODS Two cases of PCA aneurysms at the P2-P3 junction were treated using TVA in 2019. Navigation-guided entry via the interparietal sulcus was planned. Ventriculostomy was performed from the cortex to the lateral ventricle's atrium. Medial atrial floor dissection exposed PCA's P2-P3 segments. Neuronavigation and ultrasound-aided guidance was used. Anatomical studies on fixed and contrast-perfused specimens refined the approach. RESULTS Both cases saw successful aneurysm clipping. The unruptured aneurysm patient was discharged in 6 days. The poor-grade SAH patient required extended ICU care, moving to rehabilitation with mRS = 4. The unruptured complex aneurysm case exhibited no deficits, returning to work in 3 months. Anatomical dissections validated TVA for high-located P2-P3 junction PCA aneurysms. CONCLUSION While endovascular therapy remains primary, this study demonstrates the viability of navigation-guided TVA for select high-located P2-P3 junction PCA aneurysms. Successes and challenges underscore the importance of patient selection and anatomical awareness.
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Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Mooren Str. 5, 40225, Düsseldorf, Germany.
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan.
| | - Rui Zhang
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Mooren Str. 5, 40225, Düsseldorf, Germany
- Department of Neurosurgery, Xingtai People's Hospital Hebei Medical University, Xingtai, China
| | - Timm Filler
- Institute for Anatomy I, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Mooren Str. 5, 40225, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Mooren Str. 5, 40225, Düsseldorf, Germany
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
- International Neuroscience Institute (INI), Rudolf-Pichlmayr-Straße 4, 30625, Hannover, Germany
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital of Denmark, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Besta NeuroSim Center, Department of Neurological Surgery, Instituto Nazionale Neurologico "C. Besta,", Milan, Italy
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Bamimore MA, Marenco-Hillembrand L, Ravindran K, Agyapong D, Greco E, Middlebrooks EH, Chaichana KL. Management of Intraventricular Meningiomas. Neurosurg Clin N Am 2023; 34:403-415. [PMID: 37210129 DOI: 10.1016/j.nec.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Intraventricular meningiomas (IVM) are intracranial tumors that originate from collections of arachnoid cells within the choroid plexus. The incidence of meningiomas is estimated to be about 97.5 per 100,000 individuals in the United States with IVMs constituting 0.7% to 3%. Positive outcomes have been observed with surgical treatment of intraventricular meningiomas. This review explores elements of surgical care and management of patients with IVM, highlighting nuances in surgical approaches, their indications, and considerations.
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Affiliation(s)
- Michael A Bamimore
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Neurological Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Lina Marenco-Hillembrand
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Krishnan Ravindran
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - David Agyapong
- School of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elena Greco
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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The posterior interhemispheric transparieto-occipital fissure approach to the atrium of the lateral ventricle: a fiber microdissection study with case series. Neurosurg Rev 2021; 45:1663-1674. [PMID: 34822014 DOI: 10.1007/s10143-021-01693-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The surgical approach to the atrium of the lateral ventricle remains a challenge because of its deep location and close relationship to important neurovascular structures. We present an alternative and safer approach to lesions of the atrium using a natural pathway through the parieto-occipital fissure. We demonstrate this approach through cadaveric anatomical microdissection and a case series. Five formalin-fixed brain specimens (10 hemispheres) were dissected with the Klingler technique. Transillumination was used to show the trajectory of the approach in cadaveric specimens. Clinical data from five patients who underwent this approach were reviewed. This data included intraoperative ultrasound images, operative images, pre- and postoperative magnetic resonance imaging, MR tractography, and visual field examination. The parieto-occipital fissure is a constant, uninterrupted fissure that can be easily identified in cadavers. Our anatomical dissection study revealed that the atrium of the lateral ventricle can be approached through the parieto-occipital fissure with minor damage to the short association fibers between the precuneus and cuneus, and a few fibers of the forceps major. In our series, five patients underwent total resection of their atrial lesions via the posterior interhemispheric transparieto-occipital fissure. No morbidity or mortality was observed, and the disruption of white matter was minimal, as indicated on postoperative tractography. The postoperative visual fields were normal. The posterior interhemispheric transparieto-occipital fissure approach is an alternative to remove lesions in the atrium of the lateral ventricle, causing the least damage to white matter tracts and preserving visual cortex and optic radiation.
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DE Benedictis A, Marras CE, Petit L, Sarubbo S. The inferior fronto-occipital fascicle: a century of controversies from anatomy theaters to operative neurosurgery. J Neurosurg Sci 2021; 65:605-615. [PMID: 33940782 DOI: 10.23736/s0390-5616.21.05360-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Since its first description in the early 19th century, the inferior frontooccipital fascicle (IFOF) and its anatomo-functional features were neglected in the neuroscientific literature for the last century. In the last decade, the rapid development of in vivo imaging for the reconstruction of white matter (WM) connectivity (i.e., tractography) and the consequent interest in more traditional ex vivo methods (postmortem dissection) have allowed a renewed debate about course, termination territories, anatomical relationships, and functional roles of this fascicle. EVIDENCE ACQUISITION We reviewed the main current knowledge concerning the structural and functional anatomy of the IFOF and possible implications in neurosurgical practice. EVIDENCE SYNTHESIS The IFOF connects the occipital cortex, the temporo-basal areas, the superior parietal lobule, and the pre-cuneus to the frontal lobe, passing through the ventral third of subinsular WM of the external capsule. This wide distribution of cortical terminations provides multimodal integration between several functional networks, including language, non-verbal semantic processing, object identification, visuo-spatial processing and planning, reading, facial expression recognition, memory and conceptualization, emotional and neuropsychological behavior. This anatomo-functional organization has important implication also in neurosurgical practice, especially when approaching the frontal, insular, temporo-parieto-occipital regions and the ventricular system. CONCLUSIONS The IFOF is the most extensive associative bundle of the human connectome. Its multi-layer organization reflects important implications in many aspects of brain functional processing. Accurate awareness of IFOF functional anatomy and integration between multimodal datasets coming from different sources has crucial implications for both neuroscientific knowledge and quality of neurosurgical treatments.
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Affiliation(s)
- Alessandro DE Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy -
| | - Carlo E Marras
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut Des Maladies Neurodégénératives, UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab, S. Chiara Hospital, Trento, Italy
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Bugain M, Dimech Y, Torzhenskaya N, Thiebaut de Schotten M, Caspers S, Muscat R, Bajada CJ. Occipital Intralobar fasciculi: a description, through tractography, of three forgotten tracts. Commun Biol 2021; 4:433. [PMID: 33785859 PMCID: PMC8010026 DOI: 10.1038/s42003-021-01935-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/03/2021] [Indexed: 02/01/2023] Open
Abstract
Diffusion MRI paired with tractography has facilitated a non-invasive exploration of many association, projection, and commissural fiber tracts. However, there is still a scarcity of research studies related to intralobar association fibers. The Dejerines' (two of the most notable neurologists of 19th century France) gave an in-depth description of the intralobar fibers of the occipital lobe. Unfortunately, their exquisite work has since been sparsely cited in the modern literature. This work gives a modern description of many of the occipital intralobar lobe fibers described by the Dejerines. We perform a virtual dissection and reconstruct the tracts using diffusion MRI tractography. The dissection is guided by the Dejerines' treatise, Anatomie des Centres Nerveux. As an accompaniment to this article, we provided a French-to-English translation of the treatise portion concerning five intra-occipital tracts, namely: the stratum calcarinum, the stratum proprium cunei, the vertical occipital fasciculus of Wernicke, the transverse fasciculus of the cuneus and the transverse fasciculus of the lingual lobule of Vialet. It was possible to reconstruct all but one of these tracts. For completeness, the recently described sledge runner fasciculus, although not one of the Dejerines' tracts, was identified and successfully reconstructed.
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Affiliation(s)
- Maeva Bugain
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, The University of Malta, Msida, Malta
| | - Yana Dimech
- Department of Cognitive Sciences, Faculty of Media and Knowledge Sciences, The University of Malta, Msida, Malta
| | - Natalia Torzhenskaya
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, The University of Malta, Msida, Malta
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives -UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
- Institute for Anatomy I, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Richard Muscat
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, The University of Malta, Msida, Malta
| | - Claude J Bajada
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, The University of Malta, Msida, Malta.
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany.
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