Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France.
Department of Neurosurgery, Pitié Salpêtrière Hospital, 43-81, bd de l'Hôpital, 73013, Paris, France.
Neurosurg Rev. 2021 Oct;44(5):2831-2835. doi: 10.1007/s10143-021-01480-x. Epub 2021 Jan 19.
Preserving cortical frontal bridging veins draining into the superior sagittal sinus is a factor of good neurological outcome in anterior interhemispheric transcallosal approaches, classically performed to reach intraventricular tumors. Challenging the idea that veins are utterly variable, we propose a statistical analysis of 100 selective cerebral angiographies to determine where to place the craniotomy in order to expose the most probable vein-free area. The mean distance to the first pre-coronal vein was 6.66 cm (± 1.73, 1.80 to 13.00) and to the first post-coronal vein 0.94 cm (± 0.92, 0 to 3.00) (p < 0.001). The probability of absence of bridging veins was 92.0% at 4 cm anterior to the coronal suture versus 37.5% at 1 cm and 12.5% at 2 cm posteriorly. The length of the surgical corridor (distance between the first pre-coronal and post-coronal vein) was 7.60 cm (± 1.72, 3.00 to 14.10). Overall, the ideal centering point of the craniotomy was 2.86 cm (± 1.08, - 0.65 to 6.50) ahead of the coronal suture. The mean number of veins within 6 cm behind the coronal suture was 8.47 (± 2.11, from 3 to 15) versus 0.530 (± 0.82, from 0 to 3) ahead of the coronal suture (p < 0.001). These findings support a purely pre-coronal 5 cm craniotomy for interhemispheric approaches.
保留流入上矢状窦的皮质额桥静脉是前纵裂间经胼胝体入路获得良好神经预后的一个因素，该入路经典地用于到达脑室肿瘤。我们挑战静脉完全可变的观点，提出了一项对 100 例选择性脑血管造影术的统计分析，以确定放置颅骨切开术的位置，以便暴露最可能无静脉的区域。到第一条冠状前静脉的平均距离为 6.66 厘米（±1.73，1.80 至 13.00），到第一条冠状后静脉为 0.94 厘米（±0.92，0 至 3.00）（p＜0.001）。冠状缝前 4 厘米处无桥静脉的概率为 92.0％，而在 1 厘米和 2 厘米处分别为 37.5％和 12.5％。手术通道的长度（第一条冠状前静脉和后静脉之间的距离）为 7.60 厘米（±1.72，3.00 至 14.10）。总体而言，颅骨切开术的理想中心点位于冠状缝前 2.86 厘米（±1.08，-0.65 至 6.50）。冠状缝后 6 厘米内的静脉平均数量为 8.47（±2.11，3 至 15），而冠状缝前为 0.530（±0.82，0 至 3）（p＜0.001）。这些发现支持采用纯粹的冠状前 5 厘米颅骨切开术进行半球间入路。
