Document Detail

Surgical indications and microsurgical anatomy of the transchoroidal fissure approach for lesions in and around the ambient cistern.
MedLine Citation:
PMID:  11950415     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Opening the temporal part of the choroidal fissure (CF) makes it possible to expose the crural cistern, the ambient cistern, and the medial temporal lobe. We examined the microsurgical anatomy and the surgical indications for use of the trans-CF approach. METHODS: The microsurgical anatomy encountered in the trans-CF approach for lesions in and around the ambient cistern was studied in three cadavers. On the basis of these cadaveric studies, the trans-CF approach was used during surgery in three live patients with such lesions. RESULTS: The angiographic "plexal point," which indicates the entrance of the anterior choroidal artery as it enters the temporal horn of the lateral ventricle, was thought to be a key anatomic landmark of the trans-CF approach. A cortical incision for entry into the temporal horn should be made in the inferior temporal gyrus to minimize the potential damage to the optic radiations and to the speech centers. After the CF is opened posteriorly to the plexal point between the tenia fimbria and the choroid plexus, the posterior cerebral artery (PCA) in the ambient cistern can be observed with minimal caudal retraction of the hippocampus. In this study, surgical procedures using the trans-CF approach were successfully performed on patients with high-positioned P2 aneurysms whose PCA ran close to the plexal point or higher, whose medial temporal arteriovenous malformations were fed mainly by the PCA, and whose tentorial hiatus meningiomas protruded into the temporal horn through the CF, with no resulting postoperative visual or memory disturbances. CONCLUSION: The trans-CF approach is especially useful in surgery for lesions in and around the ambient cistern.
Kiyonobu Ikeda; Katsuo Shoin; Masanao Mohri; Tamotsu Kijima; Shigeru Someya; Junkoh Yamashita
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  50     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-04-12     Completed Date:  2002-06-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1114-9; discussion 1120     Citation Subset:  IM    
Department of Neurosurgery, National Kanazawa Hospital, Kanazawa, Japan.
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MeSH Terms
Arachnoid / surgery*
Central Nervous System Diseases / surgery*
Cerebellar Neoplasms / diagnosis,  surgery
Cerebral Angiography
Choroid Plexus / anatomy & histology*,  surgery*
Intracranial Aneurysm / diagnosis,  surgery
Intracranial Arteriovenous Malformations / diagnosis,  surgery
Magnetic Resonance Imaging
Meningeal Neoplasms / diagnosis,  surgery
Meningioma / diagnosis,  surgery
Middle Aged
Neurosurgical Procedures / methods*
Subarachnoid Space
Temporal Lobe / surgery

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

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