Ca'Foncello Hospital, Treviso, Veneto, Italy.
La Sapienza University of Rome, Rome, Italy.
Neurosurg Rev. 2021 Feb;44(1):529-541. doi: 10.1007/s10143-020-01244-z. Epub 2020 Feb 8.
Surgical treatment of intraventricular lesions is challenging because of their deep location, vascularization, and their complex relationships with white matter fibers. The authors undertook this study to describe the microsurgical anatomy of the white matter fibers covering the lateral wall of the atrium and temporal horn and to demonstrate how the ipsilateral interhemispheric transprecuneal approach can be safely used to remove lesions of this region sparing the anatomo-functional integrity of the fibers themselves. A detailed description of the approach including operative measurements is also given. The Klingler' technique with progressive identification of white matter fibers covering the lateral wall of the atrium and temporal horn was performed on ten formalin-fixed human hemispheres. Then, ten fresh, non-formalin-fixed non-silicon-injected adult cadaveric heads were analyzed for the simulation of the ipsilateral interhemispheric transprecuneal approach. Three illustrative cases are presented. The simulation of the interhemispheric transprecuneal approach on ten fresh non-formalin-fixed specimens showed that a 10 to 20 mm corticotomy perpendicular to the parieto-occipital sulcus at the junction with the cingulum allows a wide corridor for the exposure of the entire atrial cavity and the posterior third of the temporal horn. The ipsilateral interhemispheric transprecuneus approach represents a safe and effective option for tumors involving the atrium and the posterior third of the temporal horn.
由于脑室病变位置深、血管丰富，且与白质纤维关系复杂，因此手术治疗极具挑战性。作者开展此项研究，旨在描述覆盖侧脑室和颞角的白质纤维的显微解剖结构，并演示如何安全地使用同侧半球间经胼胝体下入路切除该区域的病变，同时保护纤维本身的解剖和功能完整性。还详细描述了该入路，包括手术测量。在十个福尔马林固定的人类大脑半球上进行了 Klingler 技术，逐步识别覆盖侧脑室和颞角的白质纤维。然后，对十个未经福尔马林固定、未注射硅的新鲜成人尸头进行分析，以模拟同侧半球间经胼胝体下入路。介绍了三个说明性病例。在十个未经福尔马林固定的新鲜标本上模拟同侧半球间经胼胝体下入路显示，在顶枕沟与扣带回交界处垂直于顶枕沟作 10-20mm 的皮质切开，可形成一个宽阔的通道，用于暴露整个侧脑室腔和颞角的后三分之一。对于累及侧脑室和颞角后三分之一的肿瘤，同侧半球间经胼胝体下入路是一种安全有效的选择。
