Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Oper Neurosurg (Hagerstown). 2016 Dec 1;12(4):374-382. doi: 10.1227/NEU.0000000000001272.
Vertical hemispherotomy is performed in hemispheric epilepsy to disconnect commissural fibers, projecting fibers, and limbic system from the affected side of the brain with minimal parenchyma removal. However, anatomic understanding of this surgery is generally difficult.
To present the vertical hemispherotomy procedures using cadaveric brains and intraoperative photographs.
Two formalin-fixed adult cadaveric brains were used to demonstrate vertical hemispherotomy. Intraoperative photographs were taken of a 19-year-old man with intractable epilepsy due to head trauma in infancy.
After coronal skin incision along the coronal suture, bifrontal craniotomy and a C-shaped dural incision from lateral to medial to the midline are performed. The interhemispheric fissure is dissected from anterior to posterior. Interhemispheric total corpus callosotomy is performed to disconnect commissural fibers. Corticotomy on the cingulate gyrus is performed to approach the lateral ventricle. The lateral border of the thalamus is cut from posterior to anterior until exposing the inferior horn of the lateral ventricle and hippocampal head to disconnect projecting fibers. At the anteromedial side of the hippocampus, the inferior part of the amygdala and uncal gyrus is removed, exposing the basal cistern to disconnect the hippocampus and amygdala. The posterior column of the fornix at the trigone of the lateral ventricle is resected to disconnect the limbic system. Projecting fibers from the anterior frontal lobe are disconnected.
A step-by-step procedure using cadaveric brains and intraoperative photographs provide a better anatomic understanding of vertical hemispherotomy.
在半球性癫痫中进行垂直半脑切除术，以最小的实质切除去除大脑受影响侧的连合纤维、投射纤维和边缘系统。然而，这种手术的解剖学理解通常较为困难。
使用尸体脑和术中照片展示垂直半脑切除术的过程。
使用两个福尔马林固定的成人尸体脑来演示垂直半脑切除术。对一名因婴儿期头部外伤导致难治性癫痫的 19 岁男性进行了术中拍照。
沿冠状缝进行冠状皮切口后，行额顶开颅术和从外侧到内侧到中线的 C 形硬脑膜切口。从前向后解剖大脑间裂。进行胼胝体全切除术以切断连合纤维。行扣带回皮质切开术以接近侧脑室。从后向前切割丘脑的外侧边界，直到暴露侧脑室下角和海马头以切断投射纤维。在海马体的前内侧，切除杏仁核和海马钩的下部，暴露基底池以切断海马体和杏仁核。切除侧脑室三角区穹窿后柱以切断边缘系统。切断额叶前部的投射纤维。
使用尸体脑和术中照片的分步程序可更好地理解垂直半脑切除术的解剖学。
