S urgical approaches to the lateral ventricle always require passage through one and often multiple fiber tracts to reach their target. These approaches remain a challenge because of the deep location and variable shape and size of the ventricles, their covering mantle of tracts, and relationships to important neural structures such as the thalamus and internal capsule. 55,75,84 In addition, a number of tracts course in the walls of the ventricle where they are separated from the cerebrospinal fluid by only a thin layer of ependyma and would likely be exposed to the greatest possibility of damage by hydrocephalus.84,124 Recent studies have focused on the relationships of the fiber tracts to eloquent cortical areas and avoiding the optic radiations in approaches to the lateral ventricle. 16,41,48,59,63,75,89,92,94,125 The aim of the present study was to explore the relationships of the tracts to the lateral ventricles and the various surgical approaches to the ventricles and to examine the anatomy and syndromes related to ventricular enlargement. MethodsForty adult human formalin-fixed cadaveric hemispheres (20 brains) were examined under magnification that ranged from ×6 to ×40. The dura, pia, arachnoid, and surface vessels were gently removed. All specimens were frozen in water for at least 2 weeks at -16°C, as described by Klingler, to separate the tracts and facilitate dissection. 51 After freezing, the specimens were thawed and rinsed of formalin under tap water for at least 1 hour. Prior OBJECTIVEThe relationship of the white matter tracts to the lateral ventricles is important when planning surgical approaches to the ventricles and in understanding the symptoms of hydrocephalus. The authors' aim was to explore the relationship of the white matter tracts of the cerebrum to the lateral ventricles using fiber dissection technique and MR tractography and to discuss these findings in relation to approaches to ventricular lesions. METHODS Forty adult human formalin-fixed cadaveric hemispheres (20 brains) and 3 whole heads were examined using fiber dissection technique. The dissections were performed from lateral to medial, medial to lateral, superior to inferior, and inferior to superior. MR tractography showing the lateral ventricles aided in the understanding of the 3D relationships of the white matter tracts with the lateral ventricles. RESULTS The relationship between the lateral ventricles and the superior longitudinal I, II, and III, arcuate, vertical occipital, middle longitudinal, inferior longitudinal, inferior frontooccipital, uncinate, sledge runner, and lingular amygdaloidal fasciculi; and the anterior commissure fibers, optic radiations, internal capsule, corona radiata, thalamic radiations, cingulum, corpus callosum, fornix, caudate nucleus, thalamus, stria terminalis, and stria medullaris thalami were defined anatomically and radiologically. These fibers and structures have a consistent relationship to the lateral ventricles. CONCLUSIONS Knowledge of the relationship of the white matter tracts o...

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When medically intractable epilepsy is multifocal or focal but poorly localized, neuromodulation can be useful therapy. One such technique is deep brain stimulation (DBS) targeting the anterior nucleus of the thalamus (ANT). Unfortunately, the ANT is difficult to visualize in standard MRI sequences and its indirect targeting is difficult because of thalamic variability and atrophy in patients with epilepsy. The following study describes the novel use of the fast gray matter acquisition T1 inversion recovery (FGATIR) MRI sequence to delineate the mammillothalamic tract for direct targeting of the ANT through visualizing the termination of the mammillothalamic tract in the ANT.The day prior to surgery in a 19-year-old, right-handed woman with a 5-year history of epilepsy, MRI was performed on a 3-T Siemens Prisma scanner (Siemens AG, Healthcare Sector) using a 64-channel head and neck coil. As part of the imaging protocol, noncontrast magnetization-prepared rapid gradient echo (MP-RAGE) and diffusion tensor imaging (DTI) sequences were obtained for targeting purposes. The ANT was directly targeted using the FGATIR sequence, and bilateral Medtronic 3389 leads were placed. At the last follow-up (2 months), the patient reported an approximate 75% decrease in seizure frequency, as well as a decrease in seizure severity.

An increased understanding of the fiber connections and neural relationships of the NAc should allow more accurate DBS targeting for the treatment of psychiatric disorders.

OBJECTIVE A common approach to lesions of the pineal region is along the midline below the torcula. However, reports of how shifting the approach off midline affects the surgical exposure and relationships between the tributaries of the vein of Galen are limited. The purpose of this study is to examine the microsurgical and endoscopic anatomy of the pineal region as seen through the supracerebellar infratentorial approaches, including midline, paramedian, lateral, and far-lateral routes. METHODS The quadrigeminal cisterns of 8 formalin-fixed adult cadaveric heads were dissected and examined with the aid of a surgical microscope and straight endoscope. Twenty CT angiograms were examined to measure the depth of the pineal gland, slope of the tentorial surface of the cerebellum, and angle of approach to the pineal gland in each approach. RESULTS The midline supracerebellar route is the shortest and provides direct exposure of the pineal gland, although the culmen and inferior and superior vermian tributaries of the vein of Galen frequently block this exposure. The off-midline routes provide a surgical exposure that, although slightly deeper, may reduce the need for venous sacrifice at both the level of the veins from the superior cerebellar surface entering the tentorial sinuses and at the level of the tributaries of the vein of Galen in the quadrigeminal cistern, and require less cerebellar retraction. Shifting from midline to off-midline exposure also provides a better view of the cerebellomesencephalic fissure, collicular plate, and trochlear nerve than the midline approaches. Endoscopic assistance may aid exposure of the pineal gland while preserving the bridging veins. CONCLUSIONS Understanding the characteristics of different infratentorial routes to the pineal gland will aid in gaining a better view of the pineal gland and cerebellomesencephalic fissure and may reduce the need for venous sacrifice at the level of the tentorial sinuses draining the upper cerebellar surface and the tributaries of the vein of Galen.

After analysis of all evaluated factors, only bilateral hematoma was found correlated with high recurrence rate (p = 0.01), probably due to previous brain atrophy or existing coagulopathy.

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AIm: One of the most important causes of failed back surgery is the development of epidural fibrosis. Many methods and substances have been used to prevent the development of epidural fibrosis after laminectomy. In this study, effects of "manuka honey" on epidural fibrosis development after laminectomy was evaluated in rats. mATERIAl and mEThods: Subjects were divided into two groups:In Group-1 (n=8);only laminectomy was carried out in the L1 level; in group-2 (n=8), laminectomy was carried out in the L1 level and manuka honey was applied to the area. The related vertebral columns were removed en bloc 6 weeks later. Leveled sections with thicknesses of 6 mm were obtained from paraffin blocks. REsulTs:In the grading made based on the fibroblast count and scar tissue degree, it was found that epidural fibrosis developed significantly less in the group-2 as compared to the group-1, and the difference was statistically significant. CoNClusIoN:It was shown in our study that manuka honey reduces the degree of epidural fibrosis in rats following laminectomy. We believe that manuka honey, which can be used safely in the clinic for surgical wounds, can be used routinely to prevent development of epidural fibrosis following laminectomy.KEywoRds: Peridural, Epidural, Fibrosis, Laminectomy, Honey, Rat ÖZ AmAÇ: Başarısız bel cerrahisi sendromunun en önemli sebeplerinden biri epidural fibrozis (EF) gelişimidir. Laminektomi sonrası epidural fibrozis gelişimini engellemeye yönelik pek çok yöntem ve madde kullanılmıştır. Bu çalışmada, "manuka balı"nın laminektomi sonrası epidural fibrozis derecesine etkisi sıçanlarda değerlendirildi. yÖNTEm ve GEREÇlER: Denekler iki gruba ayırıldı: Grup-1'de (n=8) L1 seviyesine sadece laminektomi yapıldı, grup-2'de (n=8) L1 laminektomi yapılarak, laminektomi sahasına manuka balı uygulandı. İlgili vertebral kolonlar 6 hafta sonra en-blok olarak çıkartıldı. Parafin bloklardan 6 mm kalınlığında seviyeli kesitler alındı.BulGulAR: Skar dokusunun derecesine göre yapılan evrelemede, grup-2'de grup-1'e göre epidural fibrozisin daha düşük oranda geliştiği gösterildi. Aradaki farkın istatistiksel olarak anlamlı olduğu görüldü. Fibroblast sayısına göre yapılan evrelemede, grup-2'de grup-1'e göre daha düşük derecede epidural fibrozis geliştiği ve aradaki farkın istatistiksel olarak anlamlı olduğu tespit edildi. soNuÇ: Çalışmamızda, manuka balı'nın sıçanlarda laminektomi sonrası EF derecesini azalttığı gösterilmiştir. Cerrahi yaralarda güvenli bir şekilde klinik olarak uygulanabilen manuka balı'nnın laminektomi sonrası epidural fibrozis gelişimini önlemek amacıyla rutin olarak kullanılabileceği kanaatindeyiz.