Document Detail


Microsurgical approaches to the perimesencephalic cisterns and related segments of the posterior cerebral artery: comparison using a novel application of image guidance.
MedLine Citation:
PMID:  15157288     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the exposure obtained through six approaches to the perimesencephalic cisterns with an emphasis on exposure of the posterior cerebral artery and its branches. METHODS: Dissections in 12 hemispheres exposed the crural, ambient, and quadrigeminal cisterns and related segments of the posterior cerebral artery. A Stealth Image Guidance workstation (Medtronic Surgical Navigation Technologies, Louisville, CO) was used to compare the approaches. RESULTS: The transsylvian approach exposed the interpeduncular and crural cisterns. The subtemporal approach exposed the interpeduncular and crural cisterns as well as the lower half of the ambient cistern. Temporal lobe retraction and the position of the vein of Labbé limited exposure of the quadrigeminal cistern. Occipital transtentorial and infratentorial supracerebellar approaches exposed the quadrigeminal and lower two-thirds of the ambient cistern. Transchoroidal approaches exposed the posterior third of the crural cistern, the upper two-thirds of the ambient cistern, and the proximal quadrigeminal cistern. Transchoroidal approaches exposed the posterior portion of the P2 segment (P2p) in 9 of 10 hemispheres and were the only approaches that exposed the lateral posterior choroidal arteries and the plexal segment of the anterior choroidal artery. Occipital transtentorial and infratentorial supracerebellar approaches provided access to the P3 segment in all cases and exposed the P2p segment in 4 of 10 hemispheres. The subtemporal approach provided access to the cisternal and crural segments of the anterior choroidal and medial posterior choroidal arteries and exposed the P2p segment in 3 of 10 hemispheres. CONCLUSION: Surgical approaches to lesions of the perimesencephalic cisterns must be tailored to the site of the pathological findings. The most challenging area to expose is the upper half of the ambient cistern, particularly the P2p segment of the posterior cerebral artery.
Authors:
Arthur J Ulm; Necmettin Tanriover; Masatou Kawashima; Alvaro Campero; Frank J Bova; Arthur Rhoton
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  54     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-25     Completed Date:  2004-08-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1313-27; discussion 1327-8     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University of Florida College of Medicine, Gainesville, 32610, USA. ulmaj@neurosurgery.ufl.edu
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MeSH Terms
Descriptor/Qualifier:
Choroid / pathology,  surgery
Cisterna Magna / pathology*
Humans
Mesencephalon / pathology*
Microdissection / methods*
Neurosurgical Procedures / methods
Occipital Lobe / pathology,  surgery
Posterior Cerebral Artery / pathology*
Surgery, Computer-Assisted / methods
Temporal Lobe / pathology,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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