Abstract
Surgical access to subcortical brain lesions remains challenging due to limited visualization, narrow corridors for instrument maneuverability, and the delicate nature of the cortical and subcortical structures at risk. The success of minimally-invasive neurological surgery hinges upon effective utilization of modern neuroimaging for diagnosis and preoperative patient and approach selection, intimate knowledge of subcortical anatomy, delicate microsurgical technique, and adequate utilization of adjuvant techniques to preserve functionality and maximize safe resection. Minimally-invasive techniques strive to minimize trauma to surrounding tissues and thusly protect white matter fascicles, preserve neurological function, and reduce iatrogenic morbidity. Transsulcal-parafascicular corridors to subcortical and intraventricular regions were described based upon cadaveric, functional MRI, and diffusion tensor imaging (DTI) studies.
In this chapter, illustrative cases are used to describe anatomical and DTI considerations related to the white matter fibers involved in standard parafascicular approaches (anterior, posterior, and lateral) to subcortical regions.
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Abbreviations
- AF:
-
Arcuate fasciculus
- CF:
-
Cingulate fasciculus
- DTI:
-
Diffusion tensor imaging
- FAT:
-
Frontal aslant tract
- IFOF:
-
Inferior fronto-occipital fascicle
- ILF:
-
Inferior longitudinal fascicle
- MRI:
-
Magnetic resonance imaging
- NIHSS:
-
National Institute of Health Stroke Score
- OR:
-
Optic radiations
- SFS:
-
Superior frontal sulcus
- SLF:
-
Superior longitudinal fasciculus
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Barbero, J.M.R., Bray, D., Pradilla, G. (2022). Standard Parafascicular Approaches to Subcortical Regions. In: Zada, G., Pradilla, G., Day, J.D. (eds) Subcortical Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-95153-5_10
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