Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar: Ipsilateral Versus Contralateral Corridors.

Autor:	Cohen-Cohen S; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of Neurological Surgery, The National Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez', Mexico City, México., Cohen-Gadol AA; Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana., Gomez-Amador JL; Department of Neurological Surgery, The National Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez', Mexico City, México., Alves-Belo JT; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Shah KJ; Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana., Fernandez-Miranda JC; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2019 Mar 01; Vol. 16 (3), pp. 351-359.
DOI:	10.1093/ons/opy173
Abstrakt:	Background: Due to the critical neurovascular structures that surround the pulvinar, deciding the best surgical approach can be challenging, with multiple options available. Objective: To analyze and compare the ipsilateral vs the contralateral version of the 2 main approaches to the cisternal pulvinar surface: paramedian supracerebellar infratentorial (PSCI) and interhemispheric occipital transtentorial (IOT). Methods: The PSCI and IOT approaches were performed on 7 formalin-fixed adult cadaveric heads to evaluate qualitatively and quantitatively the microsurgical exposure of relevant anatomic structures. We quantitatively measured the corridor distance to our target with each approach. Results: The ipsilateral PSCI approach provided an easier access and a better exposure of the anteromedial portion of the cisternal pulvinar surface. The contralateral approach provided a wider and more accessible exposure of the posterolateral portion of the cisternal pulvinar surface. When protrusion of the posterior parahippocampal gyrus above the free edge of the tentorium was present, the contralateral PSCI approach provided an unobstructed view to both areas. The IOT approach provided a better view of the anteromedial portion of the cisternal pulvinar surface, especially with a contralateral approach. Conclusion: Multiple approaches to the pulvinar have been described, modified, and improved. Based on this anatomic study we believe that although the corridor distance with a contralateral approach is longer, the surgical view and access can be better. We recommend the use of a PSCI contralateral approach especially when a significant protrusion of the posterior parahippocampal gyrus is present. (Copyright © 2018 by the Congress of Neurological Surgeons.)
Databáze:	MEDLINE
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