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Aldave G. The occipital interhemispheric transtentorial approach: historical perspective and evolution over time. Childs Nerv Syst 2024; 40:2257-2259. [PMID: 38935301 DOI: 10.1007/s00381-024-06508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Access to the pineal region has always represented a fascinating challenge to the neurosurgeons. Almost equally thrilling is the historical evolution from the hard beginnings with extremely high mortality rates to the current surgical outcomes, with excellent resection rates without long-term morbidity for most of the patients. The purpose of this paper is to provide an overview of the historical evolution of the occipital interhemispheric transtentorial (OITT) approach and its role in the development of access to the pineal region. METHODS Review of the literature highlights the occipital transtentorial approach from the historical context prior its description and the beginning to the current modifications and new recent insights. RESULTS The occipital transtentorial approach described initially by Poppen in 1966 has played a key role in the progress and success accessing the pineal area. CONCLUSION This historical review aims to highlight the extraordinary effort of those neurosurgeons who guided and led the development of one of the most important approaches to the pineal region.
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Affiliation(s)
- Guillermo Aldave
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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Wang Q, Qi L, He C, Fan D, Zhang H, Zhang H, Cheng W, Xie C. Occipital connectivity networks mediate the neural effects of childhood maltreatment on depressive symptoms in major depressive disorder. Asian J Psychiatr 2024; 97:104093. [PMID: 38823080 DOI: 10.1016/j.ajp.2024.104093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Childhood maltreatment (CM) is a well-established risk factor for major depressive disorder (MDD). The neural mechanisms linking childhood maltreatment experiences to changes in brain functional networks and the onset of depression are not fully understood. METHODS In this study, we enrolled 66 patients with MDD and 31 healthy controls who underwent resting-state fMRI scans and neuropsychological assessments. We employed multivariate linear regression to examine the neural associations of CM and depression, specifically focusing on the bilateral occipital functional connectivity (OFC) networks relevant to MDD. Subsequently, a two-step mediation analysis was conducted to assess whether the OFC network mediated the relationship between CM experiences and the severity of depression. RESULTS Our study showed that patients with MDD exhibited reduced OFC strength, particularly in the occipito-temporal, parietal, and premotor regions. These reductions were negatively correlated with CM scores and the severity of depression. Notably, the overlapping regions in the bilateral OFC networks, affected by both CM experiences and depressive severity, were primarily observed in the bilateral cuneus, left angular and calcarine, as well as the right middle frontal cortex and superior parietal cortex. Furthermore, the altered strengths of the OFC networks were identified as positive mediators of the impact of CM history on depression symptoms in patients with MDD. CONCLUSION We have demonstrated that early exposure to CM may increase vulnerability to depression by influencing the brain's network. These findings provide new insights into understanding the pathological mechanism underlying depressive symptoms induced by CM.
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Affiliation(s)
- Qing Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Lingyu Qi
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Cancan He
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China; Neuropsychiatric Institute, Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu 210009, China
| | - Dandan Fan
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Haisan Zhang
- Department of Radiology, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453002, China; Xinxiang Key Laboratory of Multimodal Brain Imaging, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453002, China
| | - Hongxing Zhang
- Department of Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453002,China; Psychology School of Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Weirong Cheng
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, China.
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China; Neuropsychiatric Institute, Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu 210009, China; The Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, Jiangsu 210009, China.
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Takami H, Tanaka S, Takayanagi S, Nakatomi H, Saito N. Indocyanine green illuminates the way to cut the tentorium in occipital transtentorial approach: technical note. Br J Neurosurg 2023; 37:1925-1927. [PMID: 34009080 DOI: 10.1080/02688697.2021.1927982] [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: 08/21/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND IMPORTANCE The occipital transtentorial approach is used to address lesions at the posterior incisural space or upper cerebellum. This approach is rarely used, making standardization of the surgical procedure challenging. Here we describe the effectiveness of indocyanine green (ICG) and dye markings before tentorial incision in charting a safe and bloodless surgical trajectory for improved manoeuvrability. CLINICAL PRESENTATION The first case was a 40-year-old man with a residual pineal mass after chemoradiation therapy for pathologically-proven germinoma. Surgical resection was performed via left occipital craniotomy. Incision of the left cerebellar tentorium by a radiofrequency knife was preceded by visualization of the straight sinus and venous lake, which were marked with dye, enabling safe entry into the quadrigeminal cistern. Finally, total-resection of the mature teratoma was achieved. The second case was a 50-year-old man with an enhancing mass at the cerebellar vermis and left hemisphere. Left occipital craniotomy was followed by ICG administration, illuminating the straight sinus and a complex structure of dural venous channels, which were marked with dye. This visualization maximized the tentorial incision by carefully avoiding venous structures and widely exposed the upper cerebellum. Subtotal-resection of the tumor was achieved, with a diagnosis of glioblastoma. CONCLUSION ICG administration and dye marking are feasible and useful methods for precise identification/visualization of venous structures. They enable maximization as well as safe and appropriate tentorial incision to provide a sufficient surgical corridor for the occipital transtentorial approach.
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Affiliation(s)
- Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Shingai Y, Kanamori M, Shimoda Y, Kayano S, Nemoto H, Mugikura S, Saito R, Tominaga T. Simulation of the occipital transtentorial approach incorporating visualization of the cerebellar tentorium using three-dimensional computed tomography angiography and gadolinium-enhanced T1-weighted magnetic resonance imaging: technical note. Neurosurg Rev 2023; 46:259. [PMID: 37775599 PMCID: PMC10542293 DOI: 10.1007/s10143-023-02170-6] [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: 06/10/2023] [Revised: 08/01/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
The occipital transtentorial approach (OTA) is one of the useful approaches to the lesions of the pineal region, dorsal brainstem, and supracerebellar region. However, a wide operative field is sometimes difficult to obtain due to the tentorial sinus and bridging veins. This study evaluated the usefulness of preoperative simulation of OTA, specifically including the cerebellar tentorium in 9 patients. All patients underwent computed tomography angiography and venography and gadolinium-enhanced three-dimensional T1-weighted magnetic resonance images (Gd-3D-T1WI). The images were fused, and the cerebellar tentorium, vessels, and tumor were manually extracted from Gd-3D-T1WI to obtain the simulation images. Visualization of the cerebellar tentorium could discriminate between bridging veins from the occipital lobe and cerebellum, and recognize the site of bridging to the tentorial sinus and variants which may interfere with the tentorial incision. Simulation of the tentorial incision was also possible based on the relationships between the tumor, tentorial sinus, bridging vein, and cerebellar tentorium. The simulation suggested that safe tentorial incision was difficult in two sides because of the crossed tentorial sinus draining the left basal vein and draining veins from the glioblastoma. The OTA was performed in eight cases, and no difficulty was experienced in the tentorial incision in all cases. The simulation findings of the bridging vein and tentorial sinus were consistent with the intraoperative findings. Preoperative simulation including the cerebellar tentorium is useful for determining the optimum and safe side and required extent of the tentorial incision necessary for tumor resection with the OTA.
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Affiliation(s)
- Yuto Shingai
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yoshiteru Shimoda
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shingo Kayano
- Department of Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hitoshi Nemoto
- Department of Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Carrozzi A, Gramegna LL, Sighinolfi G, Zoli M, Mazzatenta D, Testa C, Lodi R, Tonon C, Manners DN. Methods of diffusion MRI tractography for localization of the anterior optic pathway: A systematic review of validated methods. Neuroimage Clin 2023; 39:103494. [PMID: 37651845 PMCID: PMC10477810 DOI: 10.1016/j.nicl.2023.103494] [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: 03/11/2023] [Revised: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
The anterior optic pathway (AOP) is a system of three structures (optic nerves, optic chiasma, and optic tracts) that convey visual stimuli from the retina to the lateral geniculate nuclei. A successful reconstruction of the AOP using tractography could be helpful in several clinical scenarios, from presurgical planning and neuronavigation of sellar and parasellar surgery to monitoring the stage of fiber degeneration both in acute (e.g., traumatic optic neuropathy) or chronic conditions that affect AOP structures (e.g., amblyopia, glaucoma, demyelinating disorders or genetic optic nerve atrophies). However, its peculiar anatomy and course, as well as its surroundings, pose a serious challenge to obtaining successful tractographic reconstructions. Several AOP tractography strategies have been adopted but no standard procedure has been agreed upon. We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines in order to find the combinations of acquisition and reconstruction parameters that have been performed previously and have provided the highest rate of successful reconstruction of the AOP, in order to promote their routine implementation in clinical practice. For this purpose, we reviewed data regarding how the process of anatomical validation of the tractographies was performed. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias and thus the study quality We identified thirty-nine studies that met our inclusion criteria, and only five were considered at low risk of bias and achieved over 80% of successful reconstructions. We found a high degree of heterogeneity in the acquisition and analysis parameters used to perform AOP tractography and different combinations of them can achieve satisfactory levels of anterior optic tractographic reconstruction both in real-life research and clinical scenarios. One thousand s/mm2 was the most frequently used b value, while both deterministic and probabilistic tractography algorithms performed morphological reconstruction of the tract satisfactorily, although probabilistic algorithms estimated a more realistic percentage of crossing fibers (45.6%) in healthy subjects. A wide heterogeneity was also found regarding the method used to assess the anatomical fidelity of the AOP reconstructions. Three main strategies can be found: direct visual direct visual assessment of the tractography superimposed to a conventional MR image, surgical evaluation, and computational methods. Because the latter is less dependent on a priori knowledge of the anatomy by the operator, computational methods of validation of the anatomy should be considered whenever possible.
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Affiliation(s)
- Alessandro Carrozzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy.
| | - Giovanni Sighinolfi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Pituitary Unit, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Pituitary Unit, Bologna, Italy
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - David Neil Manners
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy; Department for Life Quality Studies (QUVI), University of Bologna, Bologna, Italy
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Takahara K, Miwa T, Iwama T, Toda M. Endoscopic Occipital Transtentorial Approach for Supracerebellar Lesions. NMC Case Rep J 2023; 10:185-189. [PMID: 37465249 PMCID: PMC10351956 DOI: 10.2176/jns-nmc.2022-0363] [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: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 07/20/2023] Open
Abstract
The occipital transtentorial approach (OTA), which is often applied for superior cerebellar lesions, has an inevitable risk of homonymous hemianopsia due to the retraction of the occipital lobe. The endoscopic approach provides increased visibility of the surgical field due to the wide-angled panoramic view and is minimally invasive in approaching deep brain lesions compared to the conventional microscopic approach. However, little is known regarding endoscopic OTA for the removal of cerebellar lesions. We experienced a case of a hemangioblastoma in the paramedian superior surface of the cerebellum that was successfully treated with endoscopic OTA combined with gravity retraction while avoiding postoperative visual dysfunction. A 48-year-old woman was diagnosed with a hemangioblastoma in the superior surface of the cerebellum. She underwent tumor removal with endoscopic OTA combined with gravity retraction of the occipital lobe instead of using brain retractors. The narrower space was sufficient for surgical manipulation with a panoramic view obtained by endoscopy. The simultaneous observation of the lesion with both an endoscope and a microscope revealed the superiority of infratentorial visualization with an endoscope. Gross total removal was achieved with no postoperative complications, including visual dysfunction. Endoscopic OTA may reduce the risk of postoperative visual dysfunction because of its minimally invasive nature, which is enhanced when combined with gravity retraction. Additionally, the panoramic view of the endoscope allows favorable visualization of an infratentorial lesion, which is otherwise hidden partly by the tentorium. The use of endoscopy is compatible with OTA, and endoscopic OTA could be an option for superior cerebellar lesions for avoiding visual dysfunction.
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Affiliation(s)
- Kento Takahara
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Iwama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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7
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How effective is occipital transtentorial approach for pineal region lesions? An assessment of occipital lobe functions & surgical outcome. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Tomita T. Pediatric Pineal Region Tumors: Special Reference to Posterior Interhemispheric Trans-Tentorial Approach. Adv Tech Stand Neurosurg 2023; 48:291-325. [PMID: 37770689 DOI: 10.1007/978-3-031-36785-4_11] [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: 09/30/2023]
Abstract
Pediatric pineal region tumors consist of tumors of pineal gland origin and parapineal origin. The former are comprised of germ cell tumor (GCT) and pineal parenchymal tumor. The latter originate from the surrounding neural structures, such as the midbrain and thalamus; thus, they are often benign gliomas during childhood. Pineal region tumors often cause obstructive hydrocephalus, which is the main cause of presenting symptoms. Advanced imaging discloses precise location and extension of the tumor and associated anomalies such as hydrocephalous, dissemination, hemorrhage, etc. Hydrocephalus has been managed with CSF diversion, mostly using an endoscopic third ventriculostomy. Because of different treatment paradigms for each tumor type, histological confirmation is needed either through biopsy, tumor markers for GCTs, and/or surgical resection sampling. Radical resection of these tumors remains a challenge due to their deep-seated location and involvement of delicate neural and vascular structures. Comparison of common craniotomy approaches, occipital transtentorial (OT) and infratentorial supracerebellar (ITSC), is reviewed for their advantages and disadvantages. Surgical area exposure and blind spots are important factors for successful tumor removal. The surgical techniques and nuances that the author employs for tumor resection via a posterior interhemispheric transtentorial approach are presented.
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Affiliation(s)
- Tadanori Tomita
- Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Serrato-Avila JL, Paz Archila JA, Costa MDSD, Rocha PR, Marques SR, Moraes LOCD, Cavalheiro S, Yağmurlu K, Lawton MT, Chaddad-Neto F. Microsurgical approaches to the cerebellar interpeduncular region: qualitative and quantitative analysis. J Neurosurg 2022; 136:1410-1423. [PMID: 34678772 DOI: 10.3171/2021.6.jns204457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The cerebellar interpeduncular region (CIPR) is a gate for dorsolateral pontine and cerebellar lesions accessed through the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), or the subtemporal transtentorial approach (STa). The authors sought to compare the exposures of the CIPR region that each of these approaches provided. METHODS Three approaches were performed bilaterally in eight silicone-injected cadaveric heads. The working area, area of exposure, depth of the surgical corridor, length of the interpeduncular sulcus (IPS) exposed, and bridging veins were statistically studied and compared based on each approach. RESULTS The OTa provided the largest working area (1421 mm2; p < 0.0001) and the longest surgical corridor (6.75 cm; p = 0.0006). Compared with the SCITa, the STa provided a larger exposure area (249.3 mm2; p = 0.0148) and exposed more of the length of the IPS (1.15 cm; p = 0.0484). The most bridging veins were encountered with the SCITa; however, no significant differences were found between this approach and the other approaches (p > 0.05). CONCLUSIONS To reach the CIPR, the STa provided a more extensive exposure area and more linear exposure than did the SCITa. The OTa offered a larger working area than the SCIT and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.
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Affiliation(s)
| | | | | | - Paulo Ricardo Rocha
- 2Laboratory of Microneurosurgery Anatomy, and
- 3Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Brazil
| | | | | | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery
- 2Laboratory of Microneurosurgery Anatomy, and
| | - Kaan Yağmurlu
- 4Departments of Neurosurgery and
- 5Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Michael T Lawton
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery
- 2Laboratory of Microneurosurgery Anatomy, and
- 7Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, Brazil
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Katyal A, Jadhav A, Katyal A, Jagetia A, Bodeliwala S, Singhal GD, Nazir W, Batra V, Srivastava AK, Singh D. Occipital transtentorial approach for pineal region lesions: Addressing the controversies in conventional teaching. Surg Neurol Int 2021; 12:503. [PMID: 34754553 PMCID: PMC8571259 DOI: 10.25259/sni_168_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The occipital transtentorial (OT) approach is well-established approach for pineal region tumors and can be of choice for the lesions located around the suboccipital part of tentorium such as the quadrigeminal plate, posterior part of thalamus, tentorial surface of cerebellum, splenial region, posterior falx, and lesions around the tentorial incisura. However, it is not very much extensively used in the above-mentioned locations other than the pineal region. METHODS Thirty-one patients of pineal region lesions were operated by OT approach, the role of conventional preoperative evaluation of the anatomy of the venous sinuses, deep venous system, and tentorial angle was investigated. RESULTS A variety of lesions were operated using this approach achieving gross and near total resection in majority of the cases (76.6%), with acceptable postoperative mean modified Rankin scales (1.8). CONCLUSION The OT is a preferable approach for pineal region lesions for patients of all ages and can be tailored for achieving high resectability rates irrespective of the status of the deep venous system and tentorial angle, with reasonable postoperative surgical outcome.
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Affiliation(s)
- Abhishek Katyal
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Anil Jadhav
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Aparna Katyal
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Anita Jagetia
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Shaam Bodeliwala
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Ghanshyam Das Singhal
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Wajid Nazir
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Vineeta Batra
- Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Arvind Kumar Srivastava
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India
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11
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He J, Zhang F, Xie G, Yao S, Feng Y, Bastos DCA, Rathi Y, Makris N, Kikinis R, Golby AJ, O'Donnell LJ. Comparison of multiple tractography methods for reconstruction of the retinogeniculate visual pathway using diffusion MRI. Hum Brain Mapp 2021; 42:3887-3904. [PMID: 33978265 PMCID: PMC8288095 DOI: 10.1002/hbm.25472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/31/2022] Open
Abstract
The retinogeniculate visual pathway (RGVP) conveys visual information from the retina to the lateral geniculate nucleus. The RGVP has four subdivisions, including two decussating and two nondecussating pathways that cannot be identified on conventional structural magnetic resonance imaging (MRI). Diffusion MRI tractography has the potential to trace these subdivisions and is increasingly used to study the RGVP. However, it is not yet known which fiber tracking strategy is most suitable for RGVP reconstruction. In this study, four tractography methods are compared, including constrained spherical deconvolution (CSD) based probabilistic (iFOD1) and deterministic (SD-Stream) methods, and multi-fiber (UKF-2T) and single-fiber (UKF-1T) unscented Kalman filter (UKF) methods. Experiments use diffusion MRI data from 57 subjects in the Human Connectome Project. The RGVP is identified using regions of interest created by two clinical experts. Quantitative anatomical measurements and expert anatomical judgment are used to assess the advantages and limitations of the four tractography methods. Overall, we conclude that UKF-2T and iFOD1 produce the best RGVP reconstruction results. The iFOD1 method can better quantitatively estimate the percentage of decussating fibers, while the UKF-2T method produces reconstructed RGVPs that are judged to better correspond to the known anatomy and have the highest spatial overlap across subjects. Overall, we find that it is challenging for current tractography methods to both accurately track RGVP fibers that correspond to known anatomy and produce an approximately correct percentage of decussating fibers. We suggest that future algorithm development for RGVP tractography should take consideration of both of these two points.
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Affiliation(s)
- Jianzhong He
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of TechnologyHangzhouChina
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fan Zhang
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Guoqiang Xie
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangChina
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Center for Pituitary Tumor Surgery, Department of NeurosurgeryThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yuanjing Feng
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of TechnologyHangzhouChina
| | - Dhiego C. A. Bastos
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Yogesh Rathi
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Nikos Makris
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Departments of Psychiatry, Neurology and Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ron Kikinis
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra J. Golby
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Lauren J. O'Donnell
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Wang P, Hameed NUF, Chong ST, Fan W, Zhu K, Li W, Lin CP, Feng R, Wu J. The basal turning point of optic radiation (bTPOR): The location of optic radiation in the cerebral basal surface. Clin Neurol Neurosurg 2021; 203:106562. [PMID: 33631507 DOI: 10.1016/j.clineuro.2021.106562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUNDS Optic radiation protection is crucial in the basal temporal approach to the mesial temporal lobe. Clear description of the optic radiation in the basal brain surface is lacking. Our aim is to describe the anatomy of optic radiation in the basal cerebral surface and define safety zone of basal temporal approach avoiding of optic radiation injury. METHODS Five brain specimens (10 hemispheres) were dissected using Klingler method to observe the course of the optic radiation. Diffusion tensor imaging data of 25 volunteers were used to verify the fiber dissection results. The relationship of the optic radiation to nearby structures were illustrated and measured. RESULTS The optic radiation bends from the lateral wall of the lateral ventricle to its bottom at a basal turning point of optic radiation (bTPOR). The bTPOR is at the plane crossing the center point of the splenium of corpus callosum. MRI measurements showed no significant difference in the distance from the center of the splenium of corpus callosum and the bTPOR to the occipital pole (59.46 ± 4.338 mm vs 59.54 ± 3.805 mm, p = 0.95). Anterior to bTPOR, no optic radiation fibers were found at the basal brain surface. CONCLUSIONS The bTPOR was found as a landmark of the optic radiation in the cerebral basal surface. With neuronavigation, the splenium of corpus callosum can be a landmark of the bTPOR. By approaching mesial temporal lesions using the basal temporal approach anterior to bTPOR, optic radiation injury can be prevented.
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Affiliation(s)
- Peng Wang
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - N U Farrukh Hameed
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shin Tai Chong
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Wenke Fan
- Department of Human Anatomy and Histoembryology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Keming Zhu
- Department of Human Anatomy and Histoembryology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Wensheng Li
- Department of Human Anatomy and Histoembryology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Rui Feng
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Jinsong Wu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; Brain Function Laboratory, Department of Neurosurgery, Fudan University, Shanghai, China; Institute of Brain-Intelligence Technology, Zhangjiang Lab, Shanghai, China
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13
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TAKAYAMA Y, JIN K, OSAWA SI, IWASAKI M, UKISHIRO K, KAKISAKA Y, TOMINAGA T, YAMAMOTO T, NAKASATO N. Epilepsy in Five Long-term Survivors of Pineal Region Tumors. NMC Case Rep J 2021; 8:773-780. [PMID: 35079547 PMCID: PMC8769476 DOI: 10.2176/nmccrj.cr.2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yutaro TAKAYAMA
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka JIN
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shin-ichiro OSAWA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masaki IWASAKI
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kazushi UKISHIRO
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke KAKISAKA
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tetsuya YAMAMOTO
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Nobukazu NAKASATO
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Singh S, Srivastava AK, Gajbhiye S, Bhaisora KS, Jaiswal AK, Behari S. Venous corridors in gravity-assisted retractor-less occipito-transtentorial approach - Our experience of an avenue through the tentacles of pod. Surg Neurol Int 2020; 11:399. [PMID: 33282459 PMCID: PMC7710477 DOI: 10.25259/sni_425_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/22/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Occipital transtentorial approach for selected posterior third ventricular or retrosplenium region tumors provides an ergonomic and safe access. Over centuries, the opponents of this approach highlight the problem of postoperative visual field defect, related to the retraction of occipital lobe. The aim was to describe the surgical nuances of gravity-assisted retractor-less occipital-transtentorial approach (GAROTA) as a modification of originally described GAROTA to minimize the complications with a similar ease of surgery. Methods: In this study, we have retrospectively analyzed our prospectively maintained surgical databases of patients operated by occipito-transtentorial from 2015 to 2019. Demographic variables, preoperative and postoperative neurological deficits (especially visual field defect) were analyzed. Radiological data included relation of veins with tumor, presence of hydrocephalus, size, and extent of lesion. Results: Fifteen patients underwent GAROTA (right-sided extension, n = 7; left-sided extension, n = 4; and midline lesions, n = 4). Headaches (73.3%) and diplopia (40%) were the most common symptoms. No patient had any postoperative visual deficits in both short-term and long-term follow-up. Conclusion: A thorough anatomical knowledge of posterior third interhemispheric region in the semi-prone position is required for GAROTA. Meticulous arachnoid dissection around the deep venous complex and release of cerebrospinal fluid through the cisterns is required. Postoperative cortical vision loss may be prevented by following the key surgical principles in GAROTA.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Science, Raebareli, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjog Gajbhiye
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Suboccipital transtentorial approach to remove a cerebellar cavernous malformation adjacent to cerebellomesencephalic fissure. Acta Neurochir (Wien) 2020; 162:1767-1770. [PMID: 32436008 DOI: 10.1007/s00701-020-04412-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Microsurgical removal of cerebral cavernous malformations (CCMs) at the region of cerebellomesencephalic fissure is technical challenging. METHODS A 51-year-old gentleman complained severe vertigo and vomiting for 10 days before admission. The symptoms did not improve after medicine treatment. Neuroimaging studies in other hospital revealed a CCM and hematoma at the region of cerebellomesencephalic fissure invading both the left cerebellum and its peduncles. The CCM was successfully removed through a suboccipital transtentorial approach. The detailed surgical techniques were reported. CONCLUSION A suboccipital transtentorial approach could be used to remove CCMs at the region of cerebellomesencephalic fissure.
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Selcuk İ, Tatar I, Huri E. Cadaveric anatomy and dissection in surgical training. Turk J Obstet Gynecol 2019; 16:72-75. [PMID: 31019843 PMCID: PMC6463429 DOI: 10.4274/tjod.galenos.2018.15931] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/24/2018] [Indexed: 12/27/2022] Open
Abstract
Detailed knowledge of anatomy is an essential part of surgical practice. However, there are many drawbacks in anatomy education that make many residents feel inadequate when they start performing surgeries. Cadaveric dissection courses aim to close the gap between the anatomic knowledge and surgical practice. This review focuses on the role of cadaveric dissection on surgical education, and additionally states the panel decision of the Surgical Anatomy and Technologies Association on the proper use of cadavers.
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Affiliation(s)
- İlker Selcuk
- University of Health Sciences, Zekai Tahir Burak Woman's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Ilkan Tatar
- Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Emre Huri
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey
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Nemir J, Njirić N, Ivanković D, Barl P, Domazet I, Radoš M, Mrak G, Paladino J. Tentorial alignment and its relationship to cisternal dimensions of the pineal region: MRI anatomical study with surgical implications using the new clivotentorial method. Clin Neurol Neurosurg 2018; 172:99-104. [DOI: 10.1016/j.clineuro.2018.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
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