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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Abosch A, McDermott MW, Wilson CB (2000) Lateral ventricular tumors. In: Kaye AH, Black PML (eds) Operative neurosurgery. Churchill Livingstone, New York, pp 799–812
Amar AP, Ghosh S, Apuzzo MLJ (2004) Ventricular tumors. In: Winn HR (ed) Youmans neurological surgery. WB Saunders, Philadelphia, pp 1237–1263
Barrow DL, Dawson R (1994) Surgical management of arteriovenous malformations in the region of the ventricular trigone. Neurosurgery 35:1046–1054
Batjer H, Samson DS (1987) Surgical approaches to trigonal arteriovenous malformations. J Neurosurg 67:511–517
Campero A, Tróccoli G, Martins C, Fernandez-Miranda JC, Yasuda A, Rhoton AL Jr (2006) Microsurgical approaches to the medial temporal region: an anatomical study. Neurosurgery. 59(4 Suppl 2):ONS279–ONS307
Charalampaki P, Filippi R, Welschehold S, Conrad J, Perneczky A (2005) Tumors of the lateral and third ventricle: removal under endoscope-assisted keyhole conditions. Neurosurgery 57:302–311
Ciappetta P, Pescatori L (2017) Anatomic dissection of arachnoid membranes encircling the pituitary stalk on fresh, non-formalin-fixed specimens: anatomoradiologic correlations and clinical applications in craniopharyngioma surgery. World Neurosurg. 108:479–490
Coppens JR, Mahaney KB, Abdulrauf SI (2005) An anteromedial approach to the temporal horn to avoid injury to the optic radiation fibers and uncinate fasciculus: anatomical and technical note. Neurosurg Focus 18:E3
D’Angelo VA, Galarza M, Catapano D, Monte V, Bisceglia M, Carosi I (2005) Lateral ventricle tumors: surgical strategies according to tumor origin and development—Aseries of 72 cases. Neurosurgery 56:36–45
Fernández-Miranda JC, Rhoton AL Jr, AlvarezLinera J, Kakizawa Y, Choi C, de Oliveira EP (2008) Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery. 62:989–1028
Fornari M, Savoiardo M, Morello G, Solero CL (1981) Meningiomas of the lateral ventricles: neuroradiological and surgical considerations in 18 cases. J Neurosurg 54:64–74
Guidetti B, Delfini R, Gagliardi FM, Vagnozzi R (1985) Meningiomas of the lateral ventricles: clinical, neuroradiologic, and surgical considerations in 19 cases. Surg Neurol 24:364–370
Jun CL, Nutik SL (1985) Surgical approaches to intraventricular meningiomas of the trigone. Neurosurgery 16:416–420
Kawashima M, Li X, Rhoton AL Jr, Ulm AJ, Oka H, Fujii K (2006) Surgical approaches to the atrium of the lateral ventricle: microsurgical anatomy. Surg Neurol 65:436–445
Lawton MT, Golfinos JG, Spetzler RF (1996) The contralateral transcallosal approach: experience with 32 patients. Neurosurgery 39:729–735
Nagata S, Sasaki T (2005) Lateral transsulcal approach to asymptomatic trigonal meningiomas with correlative microsurgical anatomy: technical case report. Neurosurgery 56:E438
Pendl G, Oztürk E, Haselsberger K (1992) Surgery of tumours of the lateral ventricle. 116(2-4):128–36
Pescatori L, Tropeano MP, Manfreda A, Delfini R, Santoro A (2017) Three-dimensional anatomy of the white matter fibers of the temporal lobe: surgical implications. World Neurosurg 100:144–158
Pescatori L, Tropeano MP, Ciappetta P (2018) Meckel’s cave meningiomas: new classification system focalized on dumbbell lesions deriving from the morphometric analysis of the posterior petrous apicectomy on fresh non-formalin-fixed specimens. A Correlative Anatomoclinical Study. World Neurosurg 118:e489–e499
Piepmeier JM, Westerveld M, Spencer DD, Sass KJ (1995) Surgical management of intraventricular tumors of the lateral ventricles. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques: indications, methods, and results. WB Saunders, Philadelphia, pp 725–738
Rhoton AL Jr (2002) The lateral and third ventricles. Neurosurgery 51:S207–S271
Sincoff EH, Tan Y, Abdulrauf SI (2004) White matter fiber dissection of the optic radiations of the temporal lobe and implications for surgical approaches to the temporal horn. J Neurosurg 101:739–746
Türe U, Harput MV, Kaya AH, Baimedi P, Firat Z, Türe H, Bingöl CA (2012) The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study. Laboratory investigation. J Neurosurg 116(4):773–791
Türe U, Yasargil MG, Friedman AH, Al-Mefty O (2000) Fiber dissection technique: lateral aspect of the brain. Neurosurgery 47:417–427
Wang S, Salma A, Ammirati M (2010) Posterior interhemispheric transfalx transprecuneus approach to the atrium of the lateral ventricle: a cadaveric study. J Neurosurg 113(5):949–954
Wen HT, Rhoton AL Jr, de Oliveira E, Cardoso AC, Tedeschi H, Baccanelli M et al (1999) Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery. 45:549–592
Wen HT, Rhoton AL Jr, de Oliveira E, Castro LH, Figueiredo EG, Teixeira MJ (2009) Microsurgical anatomy of the temporal lobe: part 2-Sylvian fissure region and its clinical application. Neurosurgery. 65:1–35
Xie T, Sun C, Zhang X, Zhu W, Zhang J, Gu Y, Li W (2015) The contralateral transfalcine transprecuneus approach to the atrium of the lateral ventricle: operative technique and surgical results. Neurosurgery. 11(Suppl 2):110–117
Yaşargil MG, Abdulrauf SI (2008) Surgery of intraventricular tumors. Neurosurgery. 62(6 Suppl 3):1029–1040. https://doi.org/10.1227/01.neu.0000333768.12951.9a discussion 1040-1. Review
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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
- Intraventricular tumor
- Interhemispheric approach
- Surgical management
- Superior longitudinal fasciculus