Keyhole Supracerebellar Transtentorial Transcollateral Sulcus Approach to the Lateral Ventricle

Marcus, Hani J.; Sarkar, Hrishikesh; Mindermann, Thomas; Reisch, Róbert

doi:10.1227/01.neu.0000430294.16175.20

Cited by 16 publications

(20 citation statements)

References 10 publications

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“…21,23 In our series, as in all reported cases of SCTT approaches, 3,[7][8][9]11,16,21,22,24,25,28 no CSF leakages were observed. Furthermore, the paramedian approach may avoid the median vermian bridging veins, thus avoiding venous sacrifice in three-quarters of patients.…”

Section: 24supporting

confidence: 56%

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The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

Weil¹,

Middleton²,

Niazi³

et al. 2015

PED

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OBJECT Operations on tumors of the posteromedial temporal (PMT) region, that is, on those arising from the posterior parahippocampal, fusiform, and lingual gyri, are challenging to perform because of the deep-seated location of these tumors between critical cisternal neurovascular structures and the adjacent temporal and occipital cortexes. Traditional surgical approaches require temporal or occipital transgression, retraction, or venous sacrifice. These approaches may result in unintended complications that should be avoided. To avoid these complications, the supracerebellar-transtentorial (SCTT) approach to this region has been used as an effective alternative treatment in adult patients. The SCTT approach uses a sitting position that offers a direct route to the posterior fusiform and lingual gyri of the temporal lobe. The authors report the feasibility, safety, and efficacy of this approach, using a modified lateral park-bench position in a small cohort of pediatric patients. METHODS The authors carried out a retrospective case review of 5 consecutive patients undergoing a paramedian SCTT approach between 2009 and 2014 at the authors' institution. RESULTS The SCTT approach in the park-bench position was used in 3 boys and 2 girls with a mean age of 7.8 years (range 13 months to 16 years). All patients presented with a seizure disorder related to a tumor in a PMT region involving the parahippocampal and fusiform gyri of the left (n = 3) or right (n = 2) temporal lobe. No procedure-related complications were observed. Gross-total resection and control of seizures were achieved in all cases. Tumor classes and types included 1 Grade II astrocytoma, 1 pleomorphic xanthoastrocytoma, 1 ganglioglioma, and 2 glioneural tumors. None of the tumors had recurred by the mean follow-up of 22 months (range 1–48 months). Outcomes of epileptic seizures were excellent, with seizure symptoms in all 5 patients scoring in Engel Class IA. CONCLUSIONS The SCTT approach represents a viable option when resecting tumors in this region, providing a reasonable working corridor and low morbidity. The authors' experience in a cohort of pediatric patients demonstrates that complete resection of the lesions in this location is feasible and is safe when involving an approach that involves using a park-bench lateral positioning.

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Section: 24supporting

confidence: 56%

“…Since its initial description by Voigt and Yaşargil in 1976, 24 the SCTT approach has been used to access atrial tumors, 8,11 petroclival or tentorial meningiomas, 22,25 middle fossa lesions, 7 and thalamic tumors. 16 In total, 44 cases of PMT-region lesions, including 21 tumors, have been resected through an SCTT approach.…”

Section: Discussionmentioning

confidence: 99%

The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

Weil¹,

Middleton²,

Niazi³

et al. 2015

PED

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“…It has been claimed that there are no white matter tracts along this route. 41,63 However, the floor of the atrium and temporal horn are covered by short association fibers and the Li-Am fasciculus, optic radiations, and cingulum fibers, with the short association fibers and the Li-Am fasciculus appearing, in this study, to have the greatest risk of damage in this approach (Table 3). To our knowledge, this is the first study to describe the relationships of the Li-Am fasciculus to other white matter tracts (cingulum, optic radiations, ILF, sledge runner, and short association fibers), and to the atrium and temporal horn of the lateral ventricle by fiber dissection technique correlated with MR tractography imaging.…”

mentioning

confidence: 65%

“…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.…”

mentioning

confidence: 99%

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The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus

Güngör¹,

Baydın²,

Middlebrooks

et al. 2017

JNS

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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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International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

Lan

Sughrue

Hopf³

et al. 2019

Neurosurg Rev

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Meeting of experts and drafting the statement Members of the expert panel met in Suzhou, China, November 5, 2018, as a subcommittee meeting at the 2018 Education Course of the ISMIN. The meeting utilized the outlines created from the literature review as a draft for structuring the discussion. Opinions of the experts were transcribed and discussed in detail to ensure that the statement best reflects the experts' view. Findings of the committee based on literature and expert opinions Commonly applied keyhole microsurgery approaches Supraorbital keyhole approach Indication (Table 1

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Keyhole Supracerebellar Transtentorial Transcollateral Sulcus Approach to the Lateral Ventricle

Cited by 16 publications

References 10 publications

The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

The supracerebellar-transtentorial approach to posteromedial temporal lesions in children with refractory epilepsy

The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

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