Surgical approaches for the lateral mesencephalic sulcus

Cavalcanti, Daniel D; Morais, Bárbara Albuquerque; Figueiredo, Eberval Gadelha; Spetzler, Robert F.; Preul, Mark C.

doi:10.3171/2019.1.jns182036

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…Even though telovelar, transvermian and supracerebellar infratentorial are the most common approaches to posterior fossa pathology, different groups described new surgical approaches to lesions within mesencephalum and fourth ventricle [ 4 , 6 , 7 , 9 , 26 ] exploring the natural fissures and CSF spaces within the posterior fossa. The fissures around the Tonsils have been extensively explored, and different names have been given to similar approaches via similar spaces and fissures [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Medial-tonsillar telovelar approach for resection of a superior medullary velum cerebral cavernous malformation: anatomical and tractography study of the surgical approach and functional implications

et al. 2020

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Background Superior medullary velum cerebral cavernous malformations pose a challenge in terms of appropriate microsurgical approach. Safe access to this deep location as well as preservation of surrounding anatomical structures, in particular the superior cerebellar peduncle just lateral to the superior medullary velum and the dentate nuclei, is paramount to achieve a good functional outcome. Methods Cadaveric dissections provide useful knowledge of the normal anatomy while tractography allows a better understanding of the individual anatomy in the presence of a lesion. The medial-tonsillar telovelar approach provides a feasible corridor for accessing superior velum cerebral cavernous malformations without compromising the fibres contained in the superior cerebellar peduncle. The major cerebellar efferents—cerebello-rubral, cerebello-thalamic and cerebello-vestibular tracts—and afferents, anterior spinocerebellar, tectocerebellar and trigeminocerebellar tracts, within the superior cerebellar peduncle are preserved, and the dentate nuclei are not affected. Results and conclusion A retraction-free exposure through this natural posterior fossa corridor allows the patient with the anatomical and functional subtract to make a good functional recovery by minimizing the risk of a superior cerebellar syndrome, ataxia, tremor and dysmetria; decomposition of movement in the ipsilateral extremities, nystagmus and hypotonia; or akinetic mutism, reduced or absent speech with onset within the first post-operative week.

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Section: Discussionmentioning

confidence: 99%

Medial-tonsillar telovelar approach for resection of a superior medullary velum cerebral cavernous malformation: anatomical and tractography study of the surgical approach and functional implications

et al. 2020

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“…14,24 Nevertheless, no clinical comparative study exists in the literature to evaluate the pros and cons of the paramedian SCIT compared with the classic midline SCIT approach. 3,[6][7][8][9][10][11][12][13][14]16 Thus, besides the surgical experience of skilled neurosurgeons presented in clinical series, a clear evidence about the differences of the two variants is lacking.…”

Section: Procedural Functionalitymentioning

confidence: 99%

“…1,2 However, no comparative clinical study has been performed so far between both SCIT approaches. [6][7][8][9][10][11][12][13][14] We aim to compare the differences of these two approaches in terms of clinical safety and procedural outcome. We hypothesized that the paramedian SCIT approach could have a better surgical performance than the midline SCIT approach in patients with pineal cysts and pineal region neoplasms undergoing surgery in sitting position.…”

Section: Introductionmentioning

confidence: 99%

Midline and Paramedian Supracerebellar Infratentorial Approach to The Pineal Region: A Comparative Clinical Study in 112 Patients

et al. 2020

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The midline supracerebellar infratentorial (SCIT) approach and its paramedian development are commonly used for dealing with pineal lesions. However, comparative clinical studies are lacking. We aim to establish the better performance of the paramedian SCIT approach in terms of clinical safety in surgically treated pineal cysts and pineal region tumors. Procedural functionality and effectiveness have been also analyzed. MethodsA comparative analysis of clinical, radiological, pathological, surgical features, and outcome was performed between 55 midline and 57 paramedian SCIT approaches that were exclusively performed in 112 patients (57 pineal cysts and 55 tumors of the pineal region) operated in sitting position by a single surgeon. Information was retrieved from hospital records and microsurgical videos. ResultsThe paramedian SCIT approach linked with less postoperative complications (OR:0.40) and less approach-related complications (OR: 0.28) than the midline SCIT approach. The SCIT paramedian approach was achieved in a shorter time, by a smaller bone flap and less complex procedural steps than the midline approach. The SCIT paramedian approach did not require the opening of the falx cerebelli, midline cerebellar retraction, section of the midline cerebellar draining veins, nor wide opening of the dura. Gross total resection, size of the lesion, microsurgical time for removal, histopathological diagnosis and postoperative outcome were statistically similar in both groups. ConclusionThe SCIT approach represents a safer and more functional approach for the removal of cysts and tumors of the pineal region than the classic midline approach, while maintaining the same effectiveness.

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“…Presigmoid and transpetrous approaches are used to reach the peritrigeminal region that is surrounded by the pyramidal tract and the pontomedulary sulcus. Lesions located at the lateral midbrain surface can be approached through the lateral mesencephalic sulcus [5,6,20].…”

Section: Introductionmentioning

confidence: 99%

Microsurgical anatomy of safe entry zones on the ventrolateral brainstem: a morphometric study

et al. 2021

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Surgery of the brainstem is challenging due to the complexity of the area with cranial nerve nuclei, reticular formation and ascending and descending bers. Safe entry zones are required to reach the intrinsic lesions of the brainstem. The aim of this study was to provide detailed measurements for anatomical landmark zones of the ventrolateral surface of the human brainstem related to previously described safe entry zones. In this study, 53 complete and 34 midsagittal brainstems were measured using a stainless caliper with an accuracy of 0.01 mm. The distance between the pontomesencephalic and bulbopontine sulci was measured as 26.94 mm. Basilar sulcus-lateral side of pons (origin of the bers of the trigeminal nerve) distance was 17.23 mm, transverse length of the pyramid 5.42 mm and vertical length of the pyramid 21.36 mm. Lateral mesencephalic sulcus was 12.73 mm, distance of the lateral mesencephalic sulcus to the oculomotor nerve 13.85 mm and distance of trigeminal nerve to the upper tip of pyramid 17.58 mm. The transverse length for the inferior olive at midpoint and vertical length were measured as 5.21 mm and 14.77 mm, consequently. The thickness of the superior colliculus was 4.36 mm, the inferior colliculus 5.06 mm; length of the tectum was 14.5 mm and interpeduncular fossa 11.26 mm. Profound anatomical knowledge and careful analysis of preoperative imaging are mandatory before surgery of the brainstem lesions. The results presented in this study will serve neurosurgeons operating in the brainstem region.

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Surgical approaches for the lateral mesencephalic sulcus

Cited by 11 publications

References 27 publications

Medial-tonsillar telovelar approach for resection of a superior medullary velum cerebral cavernous malformation: anatomical and tractography study of the surgical approach and functional implications

Medial-tonsillar telovelar approach for resection of a superior medullary velum cerebral cavernous malformation: anatomical and tractography study of the surgical approach and functional implications

Midline and Paramedian Supracerebellar Infratentorial Approach to The Pineal Region: A Comparative Clinical Study in 112 Patients

Microsurgical anatomy of safe entry zones on the ventrolateral brainstem: a morphometric study

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