The ipsilateral interhemispheric transprecuneal approach: microsurgical anatomy, indications, and neurosurgical applications

Neurosurgical Review volume 44, pages529–541(2021)Cite this article

Abstract

Surgical treatment of intraventricular lesions is challenging because of their deep location, vascularization, and their complex relationships with white matter fibers. The authors undertook this study to describe the microsurgical anatomy of the white matter fibers covering the lateral wall of the atrium and temporal horn and to demonstrate how the ipsilateral interhemispheric transprecuneal approach can be safely used to remove lesions of this region sparing the anatomo-functional integrity of the fibers themselves. A detailed description of the approach including operative measurements is also given. The Klingler’ technique with progressive identification of white matter fibers covering the lateral wall of the atrium and temporal horn was performed on ten formalin-fixed human hemispheres. Then, ten fresh, non-formalin-fixed non-silicon-injected adult cadaveric heads were analyzed for the simulation of the ipsilateral interhemispheric transprecuneal approach. Three illustrative cases are presented. The simulation of the interhemispheric transprecuneal approach on ten fresh non-formalin-fixed specimens showed that a 10 to 20 mm corticotomy perpendicular to the parieto-occipital sulcus at the junction with the cingulum allows a wide corridor for the exposure of the entire atrial cavity and the posterior third of the temporal horn. The ipsilateral interhemispheric transprecuneus approach represents a safe and effective option for tumors involving the atrium and the posterior third of the temporal horn.

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Affiliations

  1. Ca’Foncello Hospital, Treviso, Veneto, Italy

    Lorenzo Pescatori

  2. La Sapienza University of Rome, Rome, Italy

    Lorenzo Pescatori

  3. Humanitas Clinical and Research Hospital & Humanitas University, Viale Alessandro Manzoni, 56, Rozzano, Milan, Italy

    Maria Pia Tropeano

  4. Bari University Medical School, Bari, Italy

    Pasqualino Ciappetta

Authors
  1. Lorenzo Pescatori
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  2. Maria Pia Tropeano
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  3. Pasqualino Ciappetta
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Correspondence to Maria Pia Tropeano.

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Pescatori, L., Tropeano, M.P. & Ciappetta, P. The ipsilateral interhemispheric transprecuneal approach: microsurgical anatomy, indications, and neurosurgical applications. Neurosurg Rev 44, 529–541 (2021). https://doi.org/10.1007/s10143-020-01244-z

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Keywords

  • Intraventricular tumor
  • Interhemispheric approach
  • Surgical management
  • Atrium
  • Superior longitudinal fasciculus