Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Department of Neurosurgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
World Neurosurg. 2019 Aug;128:e1048-e1086. doi: 10.1016/j.wneu.2019.05.068. Epub 2019 May 17.
Approaching the thalamus from any angle remains a challenge because of its deep-seated location and intimate relations with adjacent important neurovascular structures and functions such as relaying sensory and motor signals and cognition. Our aim was to explore the relationship of the white matter tracts of the cerebrum to the thalamus using a fiber dissection technique, to delineate anatomic principles of approaches to the thalamus, and to discuss the tracts at risk in relation to each approach.
The thalamus was subdivided into 6 different regions and 13 approaches were examined in an attempt to describe a surgical road map.
To reach the anteroinferior, medial, and lateral parts of the thalamus, the anterior and middle group approaches were used, and to reach the posterosuperior and posteroinferior thalamus, posterior and middle group approaches were used. The anteroinferior zone was the most difficult site to be accessed and the posterosuperior thalamus had the maximum number of alternative approaches. The distal transsylvian approach to the posterosuperior thalamus and the supracarotid infrafrontal approach to the anteroinferior thalamus had the highest number of neural structures severed within the surgical corridor. The infratentorial approaches and the suboccipital transtentorial approach preserve most of the white matter tracts en route to the posterosuperior and medial posteroinferior parts of the thalamus.
When the surgical approaches for thalamic lesions are defined, white matter tracts along the surgical route should be taken into consideration.
由于丘脑位于深部，与相邻的重要神经血管结构和功能（如传递感觉和运动信号以及认知）关系密切，因此从任何角度接近丘脑仍然是一个挑战。我们的目的是使用纤维解剖技术探讨大脑白质束与丘脑的关系，描绘丘脑入路的解剖学原则，并讨论与每种入路相关的风险束。
将丘脑分为 6 个不同区域，并检查了 13 种入路，试图描述一种手术路线图。
为了到达丘脑的前下、内侧和外侧部分，使用了前组和中组入路，为了到达丘脑的后上和后下部分，使用了后组和中组入路。前下区是最难到达的部位，后上丘脑有最多的替代入路。远侧经颞叶入路到达后上丘脑，经颈内动脉前额下入路到达前下丘脑，在手术通道内切断的神经结构数量最多。小脑幕下入路和枕下入路经颅后窝可保留通往丘脑后上和内侧后下部分的大部分白质束。
当定义丘脑病变的手术入路时，应考虑手术路径上的白质束。
