Window anatomy for neurosurgical approaches

Kendir, Simel; Açar, Hali̇l İbrahi̇m; Cömert, Ayhan; Özdemi̇r, Mevci̇; Kahiloğulları, Gökmen; Elhan, Alai̇tti̇n; Ugur, Hasan Çağlar

doi:10.3171/2008.10.jns08159

Cited by 22 publications

(24 citation statements)

References 31 publications

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“…1,6,7,10,12,16,18,19,23 Injury of the great vessels is the most devastating complication of lumbar discectomy and has occurred primarily at the L4-5 and L5-S1 levels. 18 The use of formalin-fixed cadavers can alter anatomical relationships due to decreasing the tension within the tissues, 14,15,17 especially the thecal sac and vascular relationships with disc spaces. Therefore, a pilot study was carried out.…”

Section: Discussionmentioning

confidence: 99%

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

Arslan

Cömert²,

Açar³

et al. 2011

SPI

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Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3–11.6 mm and 8.2–10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3–4 to L5–S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root–to-disc angle gradually decreased from L-3 to S-1 (range 105°–110.6° and 99°–108°). Disc heights gradually increased from L1–2 to L5–S1 (range 11.3–17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels. Conclusions To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.

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Section: Discussionmentioning

confidence: 99%

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

Arslan

Cömert²,

Açar³

et al. 2011

SPI

Self Cite

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“…Ebeling et al [15] described the localization of the coronal suture relative to the precentral gyrus being highly variable. Kendir et al [16] reported that the precentral gyrus was located approximately 4.5 cm and the postcentral gyrus was located approximately 6.5 cm behind the bregma on the midline. Rivet et al [17] stated that the distance from the coronal suture to the motor cortex was <3 cm in children under 6 years.…”

Section: Discussionmentioning

confidence: 99%

Localization of the bregma and its clinical relevance

Solmaz

2018

Anatomy

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Objectives: External landmarks on the skull are important guides in various neurosurgical procedures. The localization of the bregma is vitally important in bedside ventriculostomy and craniotomies. The aim of the current study was to verify the localization of the bregma. Methods: This was performed on dry skulls (n=72) and sagittal computerized tomography (CT) images of patients (n=100). The age and the sex of dry skulls were unknown. Of the 100 patients, 48 were males and 52 were females and the mean age for males was 51.14 and for females was 55.34. The distance between nasion to inion and nasion to bregma were measured from both dry skulls and on multiplanar reformation (MPR) sagittal images. The ratio of the two measurements was calculated. Results: The nasion to bregma distances on 72 dry skulls ranged between 120-140 mm: the average distance was 124.3±6.9 mm. The nasion to inion distance ranged between 295-345 mm; the average was 320.8±14.4 mm. The ratio of nasion to bregma distance to nasion to inion distance was calculated as 0.384. The nasion to bregma distance obtained from 100 CT images scans ranged from 107 to 139 mm (average 126.6±7.3) mm. The nasion to inion distances ranged between 301 and 356 (average 330.2±15.2) mm. The ratio of nasion to bregma distance to nasion to inion distance was calculated as 0.383. Measurements for females were lower than males, but there was no statistical significance between genders. The multiplication of the nasion to inion distance by 0.38 gave the location of bregma for both genders. Conclusion: An accurate and reliable ratio (0.38 times the distance from nasion to inion) was obtained to define the bregma. The coronal suture lay on each side of bregma, so knowing the exact localization of bregma and of the coronal suture can be vitally important in various surgical procedures to the cranium.

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“…Postmortem measurement studies continue to be used to facilitate the intraoperative identification of sulci related to eloquent areas of the brain surface and to orient the precise placement of craniotomies. 1,3,4 The relative scarcity of autopsy material does not allow the large-scale studies necessary for statistical analyses of measurement data and individual variations. More importantly, factors such as the length of specimen fixation, which may vary across different studies, affects the results of postmortem analyses.…”

Section: Introductionmentioning

confidence: 99%

A three-dimensional MRI study of variations in central sulcus location in 40 normal subjects

Hamasaki

Imamura

Kuroda

et al. 2012

Journal of Clinical Neuroscience

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Window anatomy for neurosurgical approaches

Abstract: Given that recognition of the gyral patterns underlying the craniotomies is not always easy, awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical interventions.

Cited by 22 publications

References 31 publications

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

Localization of the bregma and its clinical relevance

A three-dimensional MRI study of variations in central sulcus location in 40 normal subjects

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