Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
World Neurosurg. 2019 Aug;128:e98-e106. doi: 10.1016/j.wneu.2019.04.034. Epub 2019 Apr 11.
The atrium is the most common location for masses in the lateral ventricle. However, access to this area is limited owing to its deep location and adjacent eloquent neurovascular structures, such as the choroidal arteries, perisylvian white matter (WM) tracts, and optic radiations. We investigated the feasibility and safety of an endoscopic approach to the atrium via the anterior middle temporal gyrus (MTG).
Radiological assessment of a minimally invasive surgical trajectory to the atrium was achieved in 10 patients. Surgical simulation to assess the feasibility of our endoscopic approach was performed on 24 cadaveric specimens using a transzygomatic corridor and temporal craniotomy. Preoperative computed tomography was performed to confirm the surgical trajectory using neuronavigation. Using Klinger's method, 5 hemispheres were dissected to assess the relationship of our approach to the WM tracts.
The optimal entry angle to reach the atrium through the anterior MTG was related to the temporal horn in the axial plane and to the Sylvian fissure in the sagittal plane. Our entry point in the anterior MTG was 19 ± 1.92 mm from the temporal pole. The transparenchymal distance to atrium was 24.55 ± 4.3 mm. The WM dissections confirmed that our approach did not violate the optic radiations, uncinate fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, or superior longitudinal fasciculus.
Our findings have confirmed the feasibility of an anterior endoscopic approach to the atrium through the anterior MTG, with preservation of the functional integrity of the eloquent cortex and WM tracts.
心房是侧脑室内最常见的肿块部位。然而，由于其位置较深，且毗邻脉络膜动脉、围侧裂白质（WM）束和视辐射等重要的神经血管结构，进入该区域的通道受到限制。我们研究了通过前颞中回（MTG）经内镜入路到达心房的可行性和安全性。
在 10 名患者中对到达心房的微创手术轨迹进行了影像学评估。通过经颧弓通道和颞骨切开术，在 24 个尸体标本上进行了手术模拟，以评估我们的内镜入路的可行性。术前进行计算机断层扫描（CT），使用神经导航确认手术轨迹。使用 Klinger 方法，对 5 个半球进行解剖，以评估我们的入路与 WM 束的关系。
通过前 MTG 到达心房的最佳进入角度与轴向平面中的颞角和矢状平面中的侧裂有关。我们在前 MTG 的进入点距离颞极 19±1.92mm。到达心房的透颅距离为 24.55±4.3mm。WM 解剖证实，我们的入路不会侵犯视辐射、钩束、下额枕束、下纵束或上纵束。
我们的研究结果证实了通过前 MTG 经内镜从前入路到达心房的可行性，同时保持了大脑皮质和 WM 束的功能完整性。
