Kassam Amin B, Monroy-Sosa Alejandro, Fukui Melanie B, Kura Bhavani, Jennings Jonathan E, Celix Juanita M, Nash Kenneth C, Kassam Mikaeel, Rovin Richard A, Chakravarthi Srikant S
Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
Neeka Health, Milwaukee, Wisconsin.
Oper Neurosurg. 2020 Sep 15;19(4):E357-E369. doi: 10.1093/ons/opaa066.
Kocher's point (KP) and its variations have provided standard access to the frontal horn (FH) for over a century. Anatomic understanding of white matter tracts (WMTs) has evolved, now positioning us to better inform the optimal FH trajectory.
To (1) undertake a literature review analyzing entry points (EPs) to the FH; (2) introduce a purpose-built WMT-founded superior frontal sulcus parafascicular (SFSP)-EP also referred to as the Kassam-Monroy entry point (KM-EP); and (3) compare KM-EP with KP and variants with respect to WMTs.
(1) Literature review (PubMed database, 1892-2018): (a) stratification based on the corridor: i. ventricular catheter; ii. through-channel endoscopic; or iii. portal; (b) substratification based on intent: i. preoperatively planned or ii. intraoperative (postdural opening) for urgent ventricular drainage. (2) Anatomic comparisons of KM-EP, KP, and variants via (a) cadaveric dissections and (b) magnetic resonance-diffusion tensor imaging computational 3D modeling.
A total of 31 studies met inclusion criteria: (a) 9 utilized KP coordinate (1 cm anterior to the coronal suture (y-axis) and 3 cm lateral of the midline (x-axis) approximated by the midpupillary line) and 22 EPs represented variations. All 31 traversed critical subcortical WMTs, specifically the frontal aslant tract, superior longitudinal fasciculus II, and inferior fronto-occipital fasciculus, whereas KM-EP (x = 2.3, y = 3.5) spares these WMTs.
KP (x = 3, y = 1) conceived over a century ago, prior to awareness of WMTs, as well as its variants, anatomically place critical WMTs at risk. The KM-EP (x = 2.3, y = 3.5) is purpose built and founded on WMTs, representing anatomically safe access to the FH. Correlative clinical safety, which will be directly proportional to the size of the corridor, is yet to be established in prospective studies.
一个多世纪以来，柯赫尔点（KP）及其变体一直是进入额叶角（FH）的标准入路。对白质束（WMTs）的解剖学认识不断发展，使我们现在能够更好地确定进入FH的最佳轨迹。
（1）进行文献综述，分析进入FH的入点（EPs）；（2）引入一种基于WMTs构建的专门的额上沟束旁（SFSP）-EP，也称为卡萨姆-蒙罗入点（KM-EP）；（3）就WMTs而言，将KM-EP与KP及其变体进行比较。
（1）文献综述（PubMed数据库，1892 - 2018年）：（a）根据通道分层：i. 脑室导管；ii. 经通道内镜；或iii. 经皮层；（b）根据目的进一步分层：i. 术前规划；或ii. 术中（硬脑膜切开后）用于紧急脑室引流。（2）通过（a）尸体解剖和（b）磁共振扩散张量成像计算三维建模对KM-EP、KP及其变体进行解剖学比较。
共有31项研究符合纳入标准：（a）9项使用KP坐标（冠状缝前1 cm（y轴），由瞳孔中线近似的中线外侧3 cm（x轴）），22个EPs代表变体。所有31个入路都穿过关键的皮质下WMTs，特别是额斜束、上纵束II和额枕下束，而KM-EP（x = 2.3，y = 3.5）可避开这些WMTs。
一个多世纪前，在尚未认识WMTs时构想的KP（x = 3，y = 1）及其变体，在解剖学上使关键的WMTs处于危险之中。KM-EP（x = 2.3，y = 3.5）是基于WMTs构建的专门入路，代表了进入FH的解剖学安全入路。前瞻性研究中尚未确定与通道大小成正比的相关临床安全性。
