Chau Anthony M T, Gagliardi Filippo, Smith Adam, Pelzer Nicholas R, Stewart Fiona, Mortini Pietro, Elbabaa Samer K, Caputy Anthony J, Gragnaniello Cristian
Macquarie Neurosurgery, Australian School of Advanced Medicine, Macquarie University Hospital, Sydney, Australia.
School of Medicine, University of New England, Armidale, Australia.
Acta Neurochir (Wien). 2016 Nov;158(11):2149-2154. doi: 10.1007/s00701-016-2960-8. Epub 2016 Sep 27.
The posterior fusiform gyrus lies in a surgically challenging region. Several approaches have been described to access this anatomical area. The paramedian supracerebellar transtentorial (SCTT) approach benefits from minimal disruption of normal neurovascular tissue. The aim of this study was to demonstrate its application to access the posterior fusiform gyrus.
Three brains and six cadaveric heads were examined. A stepwise dissection of the SCTT approach to the posterior fusiform gyrus was performed. Local cortical anatomy was studied. The operability score was applied for comparative analysis on surgical anatomy.
The major posterior landmark used to identify the fusiform gyrus with respect to the medial occipitotemporal gyrus was the collateral sulcus, which commonly bifurcated at its caudal extent. Compared with other surgical approaches addressed to access the region, SCTT demonstrated the best operability in terms of maneuverability arc. Favorable tentorial anatomy is the only limiting factor.
The supracerebellar transtentorial approach is able to provide access to the posterior fusiform gyrus via a minimally disruptive, anatomic, microsurgical corridor.
梭状回后部位于一个手术难度较大的区域。已有多种入路被描述用于进入该解剖区域。小脑幕上正中经小脑幕（SCTT）入路的优点是对正常神经血管组织的破坏最小。本研究的目的是展示其在进入梭状回后部的应用。
对3个大脑和6个尸体头部进行检查。对SCTT入路至梭状回后部进行逐步解剖。研究局部皮质解剖结构。应用可操作性评分对手术解剖进行对比分析。
用于相对于枕颞内侧回识别梭状回的主要后部标志是侧副沟，其在尾端通常分叉。与其他用于进入该区域的手术入路相比，SCTT在操作弧度方面显示出最佳的可操作性。有利的小脑幕解剖结构是唯一的限制因素。
小脑幕上经小脑幕入路能够通过一个微创、解剖性的显微手术通道进入梭状回后部。
