1Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and.
J Neurosurg. 2018 Aug;129(2):508-514. doi: 10.3171/2017.4.JNS16951. Epub 2017 Nov 3.
OBJECTIVE The authors report a novel surgical route from a superior anatomical aspect-the contralateral anterior interhemispheric-transcallosal-transrostral approach-to a lesion located in the subcallosal region. The neurosurgical approach to the subcallosal region is challenging due to its deep location and close relationship with important vascular structures. Anterior and inferior routes to the subcallosal region have been described but risk damaging the branches of the anterior cerebral artery. METHODS Three formalin-fixed and silicone-injected adult cadaveric heads were studied to demonstrate the relationships between the transventricular surgical approach and the subcallosal region. The surgical, clinical, and radiological history of a 39-year-old man with a subcallosal cavernous malformation was retrospectively used to document the neurological examination and radiographic parameters of such a case. RESULTS The contralateral anterior interhemispheric-transcallosal-transrostral approach provides access to the subcallosal area that also includes the inferior portion of the pericallosal cistern, lamina terminalis cistern, the paraterminal and paraolfactory gyri, and the anterior surface of the optic chiasm. The approach avoids the neurocritical perforating branches of the anterior communicating artery. CONCLUSIONS The contralateral anterior interhemispheric-transcallosal-transrostral approach may be an alternative route to subcallosal area lesions, with less risk to the branches of the anterior cerebral artery, particularly the anterior communicating artery perforators.
作者报告了一种从对侧前纵裂经胼胝体-额下入路（contralateral anterior interhemispheric-transcallosal-transrostral approach）的新型手术入路，该入路可用于治疗位于胼胝下区域的病变。由于该区域位置深在，且与重要的血管结构关系密切，因此对该区域进行神经外科手术具有挑战性。虽然已经描述了到达胼胝下区域的前入路和下入路，但这些入路可能会损伤大脑前动脉的分支。方法：对 3 个福尔马林固定和硅酮注射的成人尸头进行了研究，以展示经脑室手术入路与胼胝下区域之间的关系。回顾性研究了 1 例 39 岁男性患者的手术、临床和放射学病史，该患者患有胼胝下海绵状畸形，记录了该病例的神经检查和影像学参数。结果：对侧前纵裂经胼胝体-额下入路可进入胼胝下区域，该区域还包括胼周池的下部、终板池、旁正中回和旁嗅回以及视交叉的前表面。该入路可避免损伤前交通动脉的神经关键穿支。结论：对侧前纵裂经胼胝体-额下入路可能是一种治疗胼胝下区域病变的替代入路，其对大脑前动脉分支，特别是前交通动脉穿支的损伤风险较小。
