ABSTRACT
Objectives A plethora of surgical strategies have been described to reach deep-seated lesions situated within the third ventricle including the Rosenfeld, or transcallosal anterior interfoniceal (TAIF), approach. First introduced in 2001, it consists of a small callosotomy followed by the midline transseptal dissection of fornices to enter the roof of the third ventricle. The aim of this microsurgical anatomy study is to describe and show each stage of the surgical procedure, focusing on the possible trajectories to anatomical landmarks. Participants A total of 20 adult cadaveric specimens were used in this study. Using ×3 to ×40 magnifications, the surgical dissection was performed in a stepwise fashion, and the transcallosal anterior interforniceal approach was performed, analyzed, and described. Results In 5 specimens of 10, a cavum septum pellucidum was depicted. In 5 cases of 20 after the callosotomy ,the lateral ventricular cavities were reached. Different orientation of the microscope allowed us to define three surgical trajectories to visualize the region of interest without exposing important functional areas. Conclusion The TAIF represents a minimally invasive approach to the third ventricle; its tricky surgical steps make appropriate anatomical dissection training essential to become confident and skilled in performing this approach.
ABSTRACT
BACKGROUND AND PURPOSE: The treatment of giant aneurysms of the vertebrobasilar junction remains a challenging task in neurosurgical practice, and the reference standard therapy is still under debate. Through a detailed postmortem study, we analyzed the hemodynamic factors underlying the formation and recanalization of an aneurysm located at this particular site and its anatomic configuration. METHODS: An adult fixed cadaveric specimen with a known VBJ GA, characterized radiographically and treated with endovascular embolization, was studied. 3D computational fluid dynamic models were built based on the specific angioarchitecture of the specimen, and each step of the endovascular treatment was simulated. RESULTS: The 3D CFD study showed an area of hemodynamic stress (high wall shear stress, high static pressure, high flow velocity) at the neck region of the aneurysm, matching the site of recanalization seen during the treatment period. CONCLUSIONS: Aneurysm morphologic features, location, and patient-specific angioarchitecture are the principal factors to be considered in the management of VBJ giant aneurysms. The 3D CFD study has suggested that, in the treatment of giant aneurysms, the intra-aneurysmal environment induced by partial coil or Onyx embolization may lead to hemodynamic stress at the neck region, potentially favoring recanalization of the aneurysm.
Subject(s)
Basilar Artery/physiopathology , Imaging, Three-Dimensional/methods , Intracranial Aneurysm/physiopathology , Models, Biological , Vertebral Artery/physiopathology , Adult , Angiography/methods , Angiography, Digital Subtraction/methods , Basilar Artery/diagnostic imaging , Blood Flow Velocity/physiology , Blood Pressure/physiology , Blood Viscosity/physiology , Cadaver , Computer Simulation , Embolization, Therapeutic/instrumentation , Endovascular Procedures , Hemorheology/physiology , Humans , Image Processing, Computer-Assisted/methods , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Recurrence , Retreatment , Stents , Stress, Mechanical , Thrombosis/physiopathology , Tomography, X-Ray Computed/methods , Vascular Resistance/physiology , Vertebral Artery/diagnostic imagingABSTRACT
BACKGROUND: The advent of modern computer technology has made it possible to examine not just the target point, but the entire trajectory in planning for stereotactic biopsies. METHODS: Two hundred consecutive biopsies were performed by one surgeon, utilizing a computer graphics workstation. The target point, entry point, and complete trajectory were carefully scrutinized and adjusted to minimize potential complications. RESULTS: Pathologically abnormal tissue was obtained in 197 cases (98.5%). There was no mortality in this series. Symptomatic hemorrhages occurred in 4 cases (2%). CONCLUSIONS: Computer graphics workstations facilitate safe and effective biopsies in virtually any brain area.
