Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
Oper Neurosurg (Hagerstown). 2018 Jan 1;14(1):45-50. doi: 10.1093/ons/opx060.
Posterior quadrant disconnection can be highly effective in the surgical treatment of selected cases of refractory epilepsy. The technique aims to deafferent extensive areas of epileptogenic posterior cortex from the rest of the brain by isolating the temporoparietooccipital cortex.
To describe this procedure and relevant white matter tracts with a specific emphasis on the extent of callosotomy in an anatomic study.
Twenty hemispheres were dissected according to Klingler's fiber dissection technique illustrating the peri-insular (temporal stem, superior longitudinal fasciculus, corona radiata) and mesial disconnection (mesiotemporal cortex, cingulum, and corpus callosum).
Extensive white matter tract disconnection is obtained after posterior quadrant disconnection. Callosal fibers connecting the anterior most part of the parietal cortex invariably ran through the isthmus of the corpus callosum and need to be disconnected, while frontal lobe connections including the corticospinal tract and the anterior two-thirds of the corpus callosum are spared during the procedure.
Our findings suggest the involvement of both the splenium and the isthmus in interhemispheric propagation in posterior cortex epilepsies. Sectioning the total extent of the posterior one-third of the corpus callosum might therefore be necessary to achieve optimal outcomes in posterior quadrant epilepsy surgery.
在后象限切断术在治疗特定的耐药性癫痫病例中非常有效。该技术旨在通过隔离颞顶枕皮质来使广泛的癫痫性后皮质与大脑的其他部分去传入。
描述该手术和相关的白质束，特别强调在解剖研究中的胼胝体切开术的范围。
根据 Klingler 的纤维解剖技术，解剖了 20 个半球，显示了岛周（颞干、上纵束、放射冠）和内侧分离（颞叶内侧、扣带回和胼胝体）。
在后象限切断术后，可获得广泛的白质束切断。连接顶叶最前部的胼胝体纤维总是穿过胼胝体的峡部，需要切断，而在手术过程中，额叶连接包括皮质脊髓束和胼胝体的前 2/3 则得以保留。
我们的研究结果表明，在后部皮质癫痫中，涉及到胼胝体的压部和峡部的半球间传播。因此，在后部象限癫痫手术中，为了达到最佳效果，可能需要切断胼胝体后部的全部 1/3。
