Koutsarnakis Christos, Liakos Faidon, Kalyvas Aristotelis V, Skandalakis Georgios P, Komaitis Spyros, Christidi Fotini, Karavasilis Efstratios, Liouta Evangelia, Stranjalis George
Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Clinical Neuroscience, Western General Hospital, Edinburgh, United Kingdom.
Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece.
World Neurosurg. 2017 Oct;106:339-354. doi: 10.1016/j.wneu.2017.06.161. Epub 2017 Jul 8.
To explore the superior frontal sulcus (SFS) morphology, trajectory of the applied surgical corridor, and white matter bundles that are traversed during the superior frontal transsulcal transventricular approach.
Twenty normal, adult, formalin-fixed cerebral hemispheres and 2 cadaveric heads were included in the study. The topography, morphology, and dimensions of the SFS were recorded in all specimens. Fourteen hemispheres were investigated through the fiber dissection technique whereas the remaining 6 were explored using coronal cuts. The cadaveric heads were used to perform the superior frontal transsulcal transventricular approach. In addition, 2 healthy volunteers underwent diffusion tensor imaging and tractography reconstruction studies.
The SFS was interrupted in 40% of the specimens studied and was always parallel to the interhemispheric fissure. The proximal 5 cm of the SFS (starting from the SFS precentral sulcus meeting point) were found to overlie the anterior ventricular system in all hemispheres. Five discrete white matter layers were identified en route to the anterior ventricular system (i.e., the arcuate fibers, the frontal aslant tract, the external capsule, internal capsule, and the callosal radiations). Diffusion tensor imaging studies confirmed the fiber tract architecture.
When feasible, the superior frontal transsulcal transventricular approach offers a safe and effective corridor to the anterior part of the lateral ventricle because it minimizes brain retraction and transgression and offers a wide and straightforward working corridor. Meticulous preoperative planning coupled with a sound microneurosurgical technique are prerequisites to perform the approach successfully.
探讨经额上沟经脑室入路过程中额上沟（SFS）的形态、应用手术通道的轨迹以及所穿过的白质束。
本研究纳入20个正常成人福尔马林固定的脑半球和2个尸头。记录所有标本中SFS的局部解剖、形态和尺寸。14个脑半球采用纤维解剖技术进行研究，其余6个采用冠状切面进行观察。利用尸头进行经额上沟经脑室入路手术。此外，2名健康志愿者接受了弥散张量成像和纤维束成像重建研究。
在40%的研究标本中，SFS有中断，且始终与大脑镰平行。在所有脑半球中，SFS起始于中央沟前沟交汇点的近端5 cm覆盖在前脑室系统上方。在通向脑室前系统的途中可识别出5个离散的白质层（即弓状纤维、额斜束、外囊、内囊和胼胝体辐射纤维）。弥散张量成像研究证实了纤维束结构。
在可行的情况下，经额上沟经脑室入路为进入侧脑室前部提供了一条安全有效的通道，因为它可最大限度地减少脑牵拉和脑侵犯，并提供一个宽阔且直接的工作通道。细致的术前规划和良好的显微神经外科技术是成功实施该入路的前提条件。
