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Saygi T, Avyasov R, Barut O, Daglar Z, Baran O, Hasimoglu O, Altinkaya A, Tanriover N. Microsurgical anatomy of the isthmic cingulum: a new white matter crossroad and neurosurgical implications in the posteromedial interhemispheric approaches and the glioma invasion patterns. Neurosurg Rev 2023; 46:82. [PMID: 37002437 DOI: 10.1007/s10143-023-01982-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: 12/21/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
The dichotomy of the cingulum bundle into the dorsal supracallosal and ventral parahippocampal parts is widely accepted; however, the retrosplenial component with its multiple alternative connections has not been revealed. The aim of this study was to delineate the microsurgical anatomy of a connectionally transition zone, the isthmic cingulum, in relation to the posteromedial interhemispheric access to the atrium and discuss the relevant patterns of glioma invasion on the basis of its fiber connections. White matter (WM) fibers were dissected layer by layer in a medial-to-lateral, lateral-to-medial, and posterior-to-anterior fashion. All related tracts and their connections were generated using deterministic tractography. The magnetic resonance imaging (MRI) tractography findings were correlated with those of fiber dissection. A medial parieto-occipital approach to reach the atrium was performed with special emphasis on the cingulate isthmus and underlying WM connections. The isthmic cingulum, introduced as a retrosplenial connectional crossroad for the first time, displayed multiple connections to the splenium and the superior thalamic radiations. Another new finding was the demonstration of lateral hemispheric extension of the isthmic cingulum fibers through the base of the posterior part of the precuneus at the base of the parieto-occipital sulcus. The laterally crossing cingulum fibers were interconnected with three distinct association tracts: the middle longitudinal (MdLF), the inferior frontooccipital fasciculi (IFOF), and the claustro-cortical fibers (CCF). In the process of entry to the atrium during posterior interhemispheric approaches, the splenial and thalamic connections, as well as the laterally crossing fibers of the isthmic cingulum, were all in jeopardy. The connectional anatomy of the retrosplenial area is much more complicated than previously known. The isthmic cingulum connections may explain the concept of interhemispheric and medial to lateral cerebral hemisphere invasion patterns in medial parieto-occipital and posteromesial temporal gliomas. The isthmic cingulum is of key importance in posteromedial interhemispheric approaches to both: the atrium and the posterior mesial temporal lobe.
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Affiliation(s)
- Tahsin Saygi
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Rashid Avyasov
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ozan Barut
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Daglar
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Oguz Baran
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Ozan Hasimoglu
- Department of Neurosurgery, Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayca Altinkaya
- Department of Neurology, Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necmettin Tanriover
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey.
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Cerrahpasa Street, No: 53, Fatih, Istanbul, Turkey.
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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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Campos M, Drapkin AJ. The Retrochiasmal Optic Pathway: A Link in Jeopardy. Front Surg 2020; 7:35. [PMID: 32656224 PMCID: PMC7324778 DOI: 10.3389/fsurg.2020.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 05/15/2020] [Indexed: 11/20/2022] Open
Abstract
The case of an intraventricular meningioma is presented and the visual complication incurred by its surgical resection is discussed. The importance of selecting the most optimal surgical approach and the basis for that selection are highlighted.
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Affiliation(s)
- Manuel Campos
- Department of Neurosurgery, Clínica Las Condes, Santiago, Chile
| | - Allan J Drapkin
- Department of Surgery [Neurosurgery], Jersey Shore University Medical Center, Neptune, NJ, United States
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Shan YZ, Wang ZM, Fan XT, Zhang HQ, Ren LK, Wei PH, Zhao GG. Automatic labeling of the fanning and curving shape of Meyer's loop for epilepsy surgery: an atlas extracted from high-definition fiber tractography. BMC Neurol 2019; 19:302. [PMID: 31779601 PMCID: PMC6882219 DOI: 10.1186/s12883-019-1537-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual field defects caused by injury to Meyer's loop (ML) are common in patients undergoing anterior temporal lobectomy during epilepsy surgery. Evaluation of the anatomical shapes of the curving, fanning and sharp angles of ML to guide surgeries is important but still challenging for diffusion tensor imaging. We present an advanced diffusion data-based ML atlas and labeling protocol to reproduce anatomical features in individuals within a short time. METHODS Thirty Massachusetts General Hospital-Human Connectome Project (MGH-HCP) diffusion datasets (ultra-high magnetic gradient & 512 directions) were warped to standard space. The resulting fibers were projected together to create an atlas. The anatomical features and the tractography correspondence rates were evaluated in 30 MGH-HCP individuals and local diffusion spectrum imaging data (eight healthy subjects and six hippocampal sclerosis patients). RESULTS In the atlas, features of curves, sharp angles and fanning shapes were adequately reproduced. The distances from the anterior tip of the temporal lobe to the anterior ridge of Meyer's loop were 23.1 mm and 26.41 mm on the left and right sides, respectively. The upper and lower divisions of the ML were revealed to be twisting. Eighty-eight labeled sides were achieved, and the correspondence rates were 87.44% ± 6.92, 80.81 ± 10.62 and 72.83% ± 14.03% for MGH-HCP individuals, DSI-healthy individuals and DSI-patients, respectively. CONCLUSION Atlas-labeled ML is comparable to high angular resolution tractography in healthy or hippocampal sclerosis patients. Therefore, rapid identification of the ML location with a single modality of T1 is practical. This protocol would facilitate functional studies and visual field protection during neurosurgery.
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Affiliation(s)
- Yong-Zhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Zhen-Ming Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiao-Tong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Hua-Qiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Lian-Kun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China.
| | - Guo-Guang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China.
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Interhemispheric Paracallosal Approach for an Arteriovenous Malformation of the Atrium: A Novel Technique. Ochsner J 2019; 19:54-58. [PMID: 30983903 DOI: 10.31486/toj.18.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Intraventricular lesions present a surgical challenge because of the complexity of the ventricular anatomy, various perforating arteries, and eloquent brain areas surrounding the system. The ventricular atrium is particularly challenging because of the cingulate gyrus, corpus callosum, optic pathways, and significant vascular structures. We present the case of a patient for whom we used a new surgical approach to reach a lesion in the ventricular atrium. Case Report: A 26-year-old male presented with an intraventricular hemorrhage, acute hydrocephalus, and a grade III arteriovenous malformation (AVM) in the atrium of the left lateral ventricle. We approached the AVM through a posterior parietooccipital paracallosal interhemispheric approach. Instead of transecting the cingulate cortex as is traditionally done, we gently retracted the cingulate gyrus and made a small paracallosal incision to reach the atrium of the left lateral ventricle. The surgery was uneventful. The patient recovered well and was discharged home on postoperative day 3 without any deficits. Conclusion: This case illustrates a novel variation to an established approach to the ventricular atrium. With this technique, the surgeon minimizes disruption of brain tissue and thereby avoids the associated postoperative deficits associated with traditional approaches (transcortical, transcingulate, and conventional transcallosal). Tractography studies and a large cohort of patients are necessary to ensure the reproduction of good outcomes.
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Yakar F, Eroglu U, Peker E, Armagan E, Comert A, Ugur HC. Structure of corona radiata and tapetum fibers in ventricular surgery. J Clin Neurosci 2018; 57:143-148. [PMID: 30166244 DOI: 10.1016/j.jocn.2018.08.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022]
Abstract
In this study the three-dimensional anatomy of the corona radiata and tapetum via the fiber dissection and diffusion tensor imaging of the brain for ventricular surgery was demonstrated. Ten formalin-fixed cerebral hemispheres were dissected for corona radiata and tapetum via Klingler's fiber dissection method under an operating microscope. The corona radiata and tapetum were dissected through lateral and medial surfaces of the cerebral hemisphere, respectively. All surgical routes for ventricular lesions were evaluated for white matter fibers during and after dissections. Corona radiata and tapetum fibers were demonstrated by dissecting hemispheres through lateral and medial aspects of the brain. The internal capsule contains all fibers that extend from thalamus to cortex and cortex to thalamus, brainstem, and spinal cord. These fan-shaped fibers extending from cortex to internal capsule were named the corona radiata. The corona radiata is not a specific pathway, and it is composed of several different fiber pathways. The tapetum contains splenium and body fibers of the corpus callosum. Tapetum is located immediately medial to the ependymal line of the ventricular wall and forms a fiber layer in the medial optical radiation on the coronal and axial sections. Surgical planning for ventricular lesions requires detailed information regarding white matter fibers that can be obtained by the fiber dissection and diffusion tensor imaging of the brain to decrease surgical complications.
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Affiliation(s)
- Fatih Yakar
- Department of Neurosurgery, Ankara University, School of Medicine, Ibni Sina Hospital, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ankara University, School of Medicine, Ibni Sina Hospital, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University, School of Medicine, Ibni Sina Hospital, Ankara, Turkey
| | - Ercan Armagan
- Neurosurgical Clinic, Dogu Anadolu Hospital, Merkez, Elazig, Turkey.
| | - Ayhan Comert
- Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey.
| | - Hasan Caglar Ugur
- Department of Neurosurgery, Ankara University, School of Medicine, Ibni Sina Hospital, Ankara, Turkey
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Hilmani S, Houass Y, El Azhari A. Paraventricular meningioma revealed by mental disorder. Surg Neurol Int 2016; 7:S1004-S1007. [PMID: 28144473 PMCID: PMC5234271 DOI: 10.4103/2152-7806.195580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ventricular meningioma constitutes 2% of intracranial meningioma, representing a challenging disease for neurosurgeons. Although cognitive impairment is one of the major symptoms of ventricular tumors, few studies have reported the details of cognitive impairment before and after their surgical removal. The expected effects on cognitive function should also be considered when choosing a surgical approach. CASE DESCRIPTIONS We report the case of a large lateral ventricle meningioma revealed by cognitive dysfunction and moderate intellectual disability. The patient underwent subtotal resection of the tumor which had partial improvement in cognitive disorders. It is important to precisely assess neuropsychological function in patients with large brain tumors, and judicious preoperative plan, adequate knowledge of anatomy, and use of correct microsurgical techniques are fundamental in achieving complete resection of paraventricular meningioma with low morbidity. CONCLUSION Pre and postoperative precise neuropsychological examinations may identify the potential cognitive impairment and beneficial effects of surgery in patients with large lateral ventricle meningiomas.
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Affiliation(s)
- Said Hilmani
- Neurosurgical Department, UHC Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Yassine Houass
- Neurosurgical Department, UHC Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Abdessamad El Azhari
- Neurosurgical Department, UHC Ibn Rochd, Hassan II University, Casablanca, Morocco
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Goga C, Türe U. The anatomy of Meyer's loop revisited: changing the anatomical paradigm of the temporal loop based on evidence from fiber microdissection. J Neurosurg 2015; 122:1253-62. [DOI: 10.3171/2014.12.jns14281] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The goal in this study was to explore and further refine comprehension of the anatomical features of the temporal loop, known as Meyer's loop.
METHODS
The lateral and inferior aspects of 20 previously frozen, formalin-fixed human brains were dissected under the operating microscope by using fiber microdissection.
RESULTS
A loop of the fibers in the anterior temporal region was clearly demonstrated in all dissections. This temporal loop, or Meyer's loop, is commonly known as the anterior portion of the optic radiation. Fiber microdissection in this study, however, revealed that various projection fibers that emerge from the sublentiform portion of the internal capsule (IC-SL), which are the temporopontine fibers, occipitopontine fibers, and the posterior thalamic peduncle (which includes the optic radiation), participate in this temporal loop and become a part of the sagittal stratum. No individual optic radiation fibers could be differentiated in the temporal loop. The dissections also disclosed that the anterior extension and angulation of the temporal loop vary significantly.
CONCLUSIONS
The fiber microdissection technique provides clear evidence that a loop in the anterior temporal region exists, but that this temporal loop is not formed exclusively by the optic radiation. Various projection fibers of the IC-SL, of which the optic radiation is only one of the several components, display this common course. The inherent limitations of the fiber dissection technique preclude accurate differentiation among individual fibers of the temporal loop, such as the optic radiation fibers.
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Affiliation(s)
- Cristina Goga
- 1Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; and
- 2Department of Anatomy, University of Medicine and Pharmacy Targu Mures, Romania
| | - Uğur Türe
- 1Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; and
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Bohnstedt BN, Kulwin CG, Shah MV, Cohen-Gadol AA. Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes. J Neurosurg 2015; 123:1045-54. [PMID: 25932608 DOI: 10.3171/2015.3.jns14847] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route. METHODS Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed. RESULTS The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5. CONCLUSIONS Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.
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Affiliation(s)
- Bradley N Bohnstedt
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Charles G Kulwin
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Mitesh V Shah
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
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Zhao X, Shen X, Chen X, Zhang J, Wang X, Zhang Y, Tu Y, Zheng G. Integrated functional neuronavigation-guided resection of small meningiomas of the atrium via the paramedian parieto-occipital approach. Clin Neurol Neurosurg 2014; 128:47-52. [PMID: 25462095 DOI: 10.1016/j.clineuro.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Small meningiomas located in the atrium of the lateral ventricle remain a challenge for neurosurgeons due to the eloquent nature of the surrounding anatomy. Functional MRI (fMRI) and diffusion tensor tractography (DTT) allow for in vivo demonstrations of eloquent cortical structures and neuronal fiber tracts, respectively. Our objective is to evaluate the contribution of functional neuronavigation combined with fMRI and DTT results to surgical outcomes. MATERIALS AND METHODS we investigated 11 patients with small meningiomas located in the atrium of the lateral ventricle who underwent surgery with the aid of functional neuronavigation via the paramedian parieto-occipital approach. The patients willingly underwent assessments of neurologic deficits preoperatively and postoperatively at discharge and at three months after surgery. RESULTS Gross total resection was achieved in all patients, and no residual or recurrent tumors were observed on follow-up imaging. There was no mortality. Only one patient suffered from transient postoperative aphasia (mild to moderate) that was resolved one week after surgery. No novel neurologic deficits were present in any of the other patients, and no new-onset epileptic attacks were observed. CONCLUSIONS With the aid of the neuronavigation that incorporates fMRI and DTT results, small meningiomas located in the atrium of the lateral ventricle can be safely resected through the paramedian parieto-occipital approach.
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Affiliation(s)
- Xin Zhao
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Xuefeng Shen
- Department of Occupational and Environmental Health and The Ministry of Education Key Laboratory of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi'an 710032, China
| | - Xiaolei Chen
- Department of Neurosurgery, PLA General Hospital, Beijing 100853, China
| | - Jiashu Zhang
- Department of Neurosurgery, PLA General Hospital, Beijing 100853, China
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Yuhui Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Yanyang Tu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA; Department of Experimental Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
| | - Gang Zheng
- Department of Neurosurgery, PLA General Hospital, Beijing 100853, China; Department of Neurosurgery, Wulumuqi General Hospital of PLA, Wulumuqi 830000, China.
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11
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Sun C, Xie T, Zhang X, Zhu W, Gu Y, Wang H. To repeat or to recreate: a contralateral posterior interhemispheric transfalcine transprecuneus approach for recurrent meningiomas at the trigone of the lateral ventricle. J Clin Neurosci 2014; 21:1968-72. [PMID: 25037312 DOI: 10.1016/j.jocn.2014.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/13/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Abstract
Surgery in the trigone of the lateral ventricle remains a challenge for neurosurgeons. In recurrent trigonal meningiomas (RTM), the disturbance of normal anatomic structures and adhesion due to previous surgeries, significant oedema, and their malignant properties heighten the difficulties associated with their surgical removal. This report presents two patients with recurrent meningiomas with anaplastic transformation at the trigone of the lateral ventricle who were successfully treated with contralateral posterior interhemispheric transfalcine transprecuneus (CITT) surgeries. The primary tumours were both completely removed through a transparietal approach in previous surgeries, but both patients experienced hemianopsia postoperatively. The second surgeries resulted in the complete resection of the recurrent tumours without any new-onset neurological dysfunction. The CITT approach suits most trigonal lesions with advantages of optic radiation preservation, reduction of retraction, improved exposure, and navigation accuracy, and because it addresses the origin of the trigonal lesion. Although the characteristics of RTM heighten the difficulty associated with their surgical removal, these challenges highlight the advantages of the CITT approach. In conclusion, the CITT approach is a safe and effective procedure for the removal of RTM.
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Affiliation(s)
- Chongjing Sun
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China; Shanghai Key Lab of Medical Image Computing and Computer Assisted Intervention, Shanghai, China.
| | - Wei Zhu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Ye Gu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Hongzhang Wang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
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Kashiwazaki D, Takaiwa A, Nagai S, Akioka N, Kurosaki K, Noguchi K, Kuwayama N, Kuroda S. Reversal of cognitive dysfunction by total removal of a large lateral ventricle meningioma: a case report with neuropsychological assessments. Case Rep Neurol 2014; 6:44-9. [PMID: 24707267 PMCID: PMC3975722 DOI: 10.1159/000358819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although cognitive impairment is one of the major symptoms of ventricular tumors, few studies have reported the details of cognitive impairment before and after their surgical removal. The expected effects on cognitive function should also be considered when choosing a surgical approach. We report the case of a large lateral ventricle meningioma in which cognitive impairment was detected on detailed neuropsychological examinations. The tumor was totally removed through the right superior temporal gyrus. Postoperative neuropsychological assessment revealed the reversal of cognitive impairment. As cognitive impairment is complex and easily overlooked, it is important to precisely assess neuropsychological function in patients with large brain tumors.
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Affiliation(s)
| | - Akiko Takaiwa
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Shoichi Nagai
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Naoki Akioka
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | | | - Kyo Noguchi
- Department of Radiology, University of Toyama, Toyama, Japan
| | - Naoya Kuwayama
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
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Vergani F, Morris CM, Mitchell P, Duffau H. Raymond de Vieussens and his contribution to the study of white matter anatomy. J Neurosurg 2012; 117:1070-5. [DOI: 10.3171/2012.8.jns12387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, there has been a renewed interest in the study of white matter anatomy, both with the use of postmortem dissections and diffusion tensor imaging tractography. One of the precursors in the study of white matter anatomy was Raymond de Vieussens (1641–1716), a French anatomist born in Le Vigan. He studied medicine at the University of Montpellier in southern France, one of the most ancient and lively schools of medicine in Europe. In 1684 Vieussens published his masterpiece, the Neurographia Universalis, which is still considered one of the most complete and accurate descriptions of the nervous system provided in the 17th century. He described the white matter of the centrum ovale and was the first to demonstrate the continuity of the white matter fibers from the centrum ovale to the brainstem. He also described the dentate nuclei, the pyramids, and the olivary nuclei. According to the theory of Galen, Vieussens considered that the function of the white matter was to convey the “animal spirit” from the centrum ovale to the spinal cord. Although neglected, Vieussens' contribution to the study of white matter is relevant. His pioneering work showed that the white matter is not a homogeneous substance, but rather a complex structure rich in fibers that are interconnected with different parts of the brain. These initial results paved the way to advancements observed in later centuries that eventually led to modern hodology.
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Affiliation(s)
- Francesco Vergani
- 1Department of Neurosurgery, Royal Victoria Infirmary
- 2Institute of Neurosciences and
| | - Christopher M. Morris
- 2Institute of Neurosciences and
- 3Medical Toxicology Centre, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Patrick Mitchell
- 1Department of Neurosurgery, Royal Victoria Infirmary
- 2Institute of Neurosciences and
| | - Hugues Duffau
- 4Department of Neurological Surgery, Hôpital Gui de Chauliac; and
- 5INSERM U1051, Institute of Neurosciences of Montpellier Hôpital Saint Eloi, CHU Montpellier, France
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Microsurgical anatomy of the temporal lobe and its implications on temporal lobe epilepsy surgery. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:769825. [PMID: 22957242 PMCID: PMC3420566 DOI: 10.1155/2012/769825] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 11/17/2022]
Abstract
Objective. We review the neuroanatomical aspects of the temporal lobe related to the temporal lobe epilepsy. The neuronal, the ventricular, and the vascular structures are demonstrated. Methods. The previous articles published from the laboratory of the senior author are reviewed. Results. The temporal lobe has four surfaces. The medial surface has a complicated microanatomy showing close relation to the intraventricular structures, such as the amygdala or the hippocampus. There are many white matter bundles in the temporal lobe showing relation to the extra- and intraventricular structures. The surgical approaches commonly performed to treat temporal lobe epilepsy are discussed under the light of these data. Conclusion. A thorough knowledge of the microanatomy is necessary in cortical, subcortical, and intraventricular structures of the temporal lobe to achieve better results.
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Characterization of visual percepts evoked by noninvasive stimulation of the human posterior parietal cortex. PLoS One 2011; 6:e27204. [PMID: 22087266 PMCID: PMC3210763 DOI: 10.1371/journal.pone.0027204] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/12/2011] [Indexed: 12/03/2022] Open
Abstract
Phosphenes are commonly evoked by transcranial magnetic stimulation (TMS) to study the functional organization, connectivity, and excitability of the human visual brain. For years, phosphenes have been documented only from stimulating early visual areas (V1–V3) and a handful of specialized visual regions (V4, V5/MT+) in occipital cortex. Recently, phosphenes were reported after applying TMS to a region of posterior parietal cortex involved in the top-down modulation of visuo-spatial processing. In the present study, we systematically characterized parietal phosphenes to determine if they are generated directly by local mechanisms or emerge through indirect activation of other visual areas. Using technology developed in-house to record the subjective features of phosphenes, we found no systematic differences in the size, shape, location, or frame-of-reference of parietal phosphenes when compared to their occipital counterparts. In a second experiment, discrete deactivation by 1 Hz repetitive TMS yielded a double dissociation: phosphene thresholds increased at the deactivated site without producing a corresponding change at the non-deactivated location. Overall, the commonalities of parietal and occipital phosphenes, and our ability to independently modulate their excitability thresholds, lead us to conclude that they share a common neural basis that is separate from either of the stimulated regions.
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Silva DOA, Matis GK, Costa LF, Kitamura MAP, Birbilis TA, Azevedo Filho HRC. Intraventricular trigonal meningioma: Neuronavigation? No, thanks! Surg Neurol Int 2011; 2:113. [PMID: 21886886 PMCID: PMC3162803 DOI: 10.4103/2152-7806.83733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 07/22/2011] [Indexed: 11/05/2022] Open
Abstract
Background: Most of the time meningiomas are benign brain tumors and surgical removal ensures cure in the vast majority of the cases. Thus, whenever possible, complete surgical resection should be the goal of the treatment. Methods: This is a report of our surgical technique for the operative resection of a trigonal meningioma in a resource-limited setting. The necessity of accurate and deep knowledge of the regional anatomy is outlined. Results: A 44-year-old male presented to our outpatient clinic complaining of cephalalgia increasing in frequency and intensity over the last month. His neurological exam was normal, yet a brain computed tomography scan revealed a lesion in the right trigone of the ventricular system. The diagnosis of possible meningioma was set. After thoroughly informing the patient, tumor resection was decided. An intraparietal sulcus approach was favored without the use of any modern technological aids such as intraoperative magnetic resonance imaging or neuronavigation. The postoperative course was uneventful and a postoperative computed tomography scan demonstrated the complete resection of the tumor. The patient was discharged two days later with no neurological deficits. In a two-year-follow-up he remains recurrence-free. Conclusion: In the current cost-effective era it is still possible to safely remove an intraventricular trigonal meningioma without the convenience of neuronavigation. Since the best neuronavigator is the profound neuroanatomical knowledge, no technological advancement could replace a well-educated and trained neurosurgeon.
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Affiliation(s)
- Danilo O A Silva
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
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Martino J, De Witt Hamer PC, Vergani F, Brogna C, de Lucas EM, Vázquez-Barquero A, García-Porrero JA, Duffau H. Cortex-sparing fiber dissection: an improved method for the study of white matter anatomy in the human brain. J Anat 2011. [DOI: 10.1111/j.1469-7580.2011.01414.x (2011)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Martino J, De Witt Hamer PC, Vergani F, Brogna C, de Lucas EM, Vázquez-Barquero A, García-Porrero JA, Duffau H. Cortex-sparing fiber dissection: an improved method for the study of white matter anatomy in the human brain. J Anat 2011; 219:531-41. [PMID: 21767263 DOI: 10.1111/j.1469-7580.2011.01414.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Classical fiber dissection of post mortem human brains enables us to isolate a fiber tract by removing the cortex and overlying white matter. In the current work, a modification of the dissection methodology is presented that preserves the cortex and the relationships within the brain during all stages of dissection, i.e. 'cortex-sparing fiber dissection'. Thirty post mortem human hemispheres (15 right side and 15 left side) were dissected using cortex-sparing fiber dissection. Magnetic resonance imaging study of a healthy brain was analyzed using diffusion tensor imaging (DTI)-based tractography software. DTI fiber tract reconstructions were compared with cortex-sparing fiber dissection results. The fibers of the superior longitudinal fasciculus (SLF), inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF) and uncinate fasciculus (UF) were isolated so as to enable identification of their cortical terminations. Two segments of the SLF were identified: first, an indirect and superficial component composed of a horizontal and vertical segment; and second, a direct and deep component or arcuate fasciculus. The IFOF runs within the insula, temporal stem and sagittal stratum, and connects the frontal operculum with the occipital, parietal and temporo-basal cortex. The UF crosses the limen insulae and connects the orbito-frontal gyri with the anterior temporal lobe. Finally, a portion of the ILF was isolated connecting the fusiform gyrus with the occipital gyri. These results indicate that cortex-sparing fiber dissection facilitates study of the 3D anatomy of human brain tracts, enabling the tracing of fibers to their terminations in the cortex. Consequently, it is an important tool for neurosurgical training and neuroanatomical research.
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Affiliation(s)
- Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain.
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Wang S, Salma A, Ammirati M. Posterior interhemispheric transfalx transprecuneus approach to the atrium of the lateral ventricle: a cadaveric study. J Neurosurg 2010; 113:949-54. [PMID: 20151777 DOI: 10.3171/2010.1.jns091169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The posterior interhemispheric transprecuneus gyrus approach is one of the surgical routes that has been suggested to reach the atrium of the lateral ventricle. It has the advantage of avoiding the disruption of the optic radiations; however, it has a narrow working area that at times makes the execution of this approach rather challenging. The aim of this study was to test a modification of the approach that might create a better surgical angle and a wider corridor by accessing the atrium from the contralateral side after transection of the falx. The authors named this new approach the "posterior interhemispheric transfalx transprecuneus approach." METHODS The posterior interhemispheic transfalx transprecuneus approach was performed bilaterally on 6 fresh adult cadaveric specimens for a total of 12 procedures. Every head was held in the semisitting position and a parasagittal parietooccipital craniotomy on the contralateral side of the targeted ventricle was executed. The dura mater was opened and reflected based on the sagittal sinus. Then the falx was cut in a triangular fashion based on the inferior sagittal sinus. Using the parietooccipital artery and sulcus as landmarks, the contralateral precuneus gyrus was indentified, and a small area of the gyrus was transected to gain access to the atrium. A neuronavigational system was also used to conduct this approach. The working angle of this approach and other distances were measured. RESULTS The authors were able to visualize the ventricular atrium, posterior part of the temporal horn, pulvinar, and choroid plexus in all specimens. The temporal horn could be exposed for a length of 20-30 mm from the atrium. The working angle of the approach was better than that of the classic posterior interhemispheric transprecuneus approach with a mean value of 44.5° as opposed to 25.8°. The distance from the middle point of the corticotomy to the splenium ranged from 11 to 16 mm (mean 13.3 mm); the distance to the torcula, from 34 to 53 mm (mean 41.3 mm); and the distance to the atrium, from 22 to 31 mm (mean 25.7 mm). CONCLUSIONS Results of this study suggested that the proposed approach can expose the atrium and the posterior part of the temporal horn of the lateral ventricle with a wider surgical angle compared with the conventional homolateral posterior interhemispheric transprecuneus gyrus approach. Moreover, by minimizing the amount of brain retraction homolateral to the target, this approach could make navigation more accurate.
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Affiliation(s)
- Song Wang
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio 43210, USA
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