Alvernia Jorge E, Lanzino Guiseppe, Melgar Miguel, Sindou Marc P, Mertens Patrick
Microsurgery Lab, Neurosurgery Department, Tulane University, New Orleans, Louisiana, USA.
Neurosurgery. 2009 Nov;65(5):962-4; discussion 964-5. doi: 10.1227/01.NEU.0000349210.98919.88.
Techniques for anterior interhemisperic craniotomy vary in respect to the degree of exposure of the superior sagittal sinus (SSS). The aim of this anatomic study is to quantify the increase in the angle of view gained by wide exposure and retraction of the SSS.
The anterior interhemispheric approach was performed in 10 cadaveric specimens with and without complete exposure and retraction of the SSS. Prespecified anatomic targets within the depth of the surgical field were used to calculate the angle of view.
Complete exposure of the SSS in the anterior interhemispheric approach, increased the angle of view from 20.6 +/- 3 to 26.8 degrees, using the A4-A5 junction as a deep anatomic target (P = 0.008). When the free edge of the falx was considered as a deep anatomic target, complete exposure of the SSS increased the working angle from 34 +/- 3.14 to 42.1 +/- 4 (P = 0.0004).
In this study, we demonstrate a significant increase in the angle of view after complete exposure of the SSS, targeting either deep (anterior cerebral artery) or more shallow structures (free falx edge).
前半球间开颅术的技术在矢状窦上矢状窦（SSS）的暴露程度方面存在差异。本解剖学研究的目的是量化通过广泛暴露和牵拉上矢状窦所获得的视角增加量。
在10个尸体标本上进行前半球间入路，分别进行上矢状窦的完全暴露和牵拉以及不进行上述操作。使用手术视野深度内预先指定的解剖靶点来计算视角。
在前半球间入路中，用上矢状窦的完全暴露以A4 - A5交界处作为深部解剖靶点时，视角从20.6±3度增加到26.8度（P = 0.008）。当将大脑镰游离缘视为深部解剖靶点时，上矢状窦的完全暴露使工作角度从34±3.14度增加到42.1±4度（P = 0.0004）。
在本研究中，我们证明了上矢状窦完全暴露后，针对深部（大脑前动脉）或较浅结构（大脑镰游离缘），视角有显著增加。
