Tumors in the pulvinar tend to present as circumscribed lesions with exophytic growth into the lateral and third ventricles. These lesions may be best explored via a parietal-transcortical-transventricular approach. If the tumor extends posteriorly or inferiorly, a posterior-interhemispheric-transtentorial approach may provide a good angle of access. Gross total removal of the tumors in the pulvinar of two patients was achieved by surgical sectioning of the unilateral crus of the fornix or the splenium via a transventricular or interhemispheric approach with acceptable risk. These patients are now doing well as students about 6 years following the first operations. During tumor removal, a posterior-interhemispheric-transtentorial approach combined with above-mentioned approaches was useful for orientation of the critical structures in the posterior incisural space. Knowledge of the anatomical relationships of the pulvinar to the crus of the fornix and the choroid plexus, and to the critical structures located in the posterior incisural space is extremely important for neurosurgeons.
A study of the arterial architecture of the orbit, especially the ophthalmic artery and the course of the posterior ciliary artery in the retroocular space, was carried out in 198 cadavers by three-dimensional arteriographic analysis. The posterior ciliary arteries were classified into three types: lateral posterior ciliary, medial posterior ciliary, and accessory posterior ciliary arteries. Both the lateral and medial posterior ciliary arteries reach the eyeball in three ways: (1) they run antero-inferiorly in a winding course to the posterior margin of the eyeball, then shift upward vertically at a 60-90 degree angle and reach the eyeball, where they divide into several ciliary branches (69%); (2) after a similar course, others branch to the eyeball from the superior side (29.3%); or (3) they reach the eyeball in an almost straight course along the optic nerve (1.7%). The fundamental characteristics of these three types of posterior ciliary artery pattern also exist in subhuman primates.
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