The Occipital Interhemispheric Transtentorial Approach for Superior Vermian, Superomedian Cerebellar, and Tectal Arteriovenous Malformations: Advantages, Limitations, and Alternatives

McLaughlin, Nancy; Martin, Neil A.

doi:10.1016/j.wneu.2013.07.075

Cited by 19 publications

(10 citation statements)

References 22 publications

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“…3 and 4). 5,18,23,38 The deficit unique to this approach is a postoperative homonymous hemianopia that is usually transient but occasionally permanent ( Table 1). The frequency of the postoperative visual field defect varies in different studies.…”

Section: Discussionmentioning

confidence: 99%

“…2). 5,18,19,23,38,42 After occipitoparietal craniotomy and dural opening, the occipital lobe is retracted away from the falx and tentorium without sacrificing bridging veins. Fortunately, there are commonly no bridging veins from the occipital lobe entering the posterior part of the superior sagittal or transverse sinuses ( Fig.…”

Section: Microsurgical Anatomy Of the Occipital Transtentorial Approachmentioning

confidence: 99%

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Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study

Matsuo

Baydın

Güngör

et al. 2018

Journal of Neurosurgery

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OBJECTIVE A postoperative visual field defect resulting from damage to the occipital lobe during surgery is a unique complication of the occipital transtentorial approach. Though the association between patient position and this complication is well investigated, preventing the complication remains a challenge. To define the area of the occipital lobe in which retraction is least harmful, the surface anatomy of the brain, course of the optic radiations, and microsurgical anatomy of the occipital transtentorial approach were examined. METHODS Twelve formalin-fixed cadaveric adult heads were examined with the aid of a surgical microscope and 0° and 45° endoscopes. The optic radiations were examined by fiber dissection and MR tractography techniques. RESULTS The arterial and venous relationships of the lateral, medial, and inferior surfaces of the occipital lobe were defined anatomically. The full course of the optic radiations was displayed via both fiber dissection and MR tractography. Although the stems of the optic radiations as exposed by both techniques are similar, the terminations of the fibers are slightly different. The occipital transtentorial approach provides access for the removal of lesions involving the splenium, pineal gland, collicular plate, cerebellomesencephalic fissure, and anterosuperior part of the cerebellum. An angled endoscope can aid in exposing the superior medullary velum and superior cerebellar peduncles. CONCLUSIONS Anatomical findings suggest that retracting the inferior surface of the occipital lobe may avoid direct damage and perfusion deficiency around the calcarine cortex and optic radiations near their termination. An accurate understanding of the course of the optic radiations and vascular relationships around the occipital lobe and careful retraction of the inferior surface of the occipital lobe may reduce the incidence of postoperative visual field defect.

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Section: Discussionmentioning

confidence: 99%

Section: Microsurgical Anatomy Of the Occipital Transtentorial Approachmentioning

confidence: 99%

Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study

Matsuo

Baydın

Güngör

et al. 2018

Journal of Neurosurgery

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“…42 The occipital transtentorial approach, which was popularized by Poppen and Jamieson, is an alternative approach to the pineal region, posterior third ventricle, and posterior aspect of the upper brainstem, especially for lesions located in the midline or extending superiorly, or for patients with a steep tentorial slope. 26,32,35,58,62,63,87 This more superior approach provides greater access to the ipsilateral half of the cerebellomesencephalic fissure, and the supra-and infracollicular areas. 59,69 Dividing the superior medullary velum after opening the cerebellomesencephalic fissure has been reported as the superior transvelar approach.…”

Section: Discussion Cerebellomesencephalic Fissurementioning

confidence: 99%

Anatomy and approaches along the cerebellar-brainstem fissures

Matsushima

Yağmurlu

Kohno

et al. 2016

JNS

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R ecent advances in microsurgical and endoscopic techniques, imaging, and electrophysiological monitoring have facilitated safe resection of brainstem lesions that were previously considered inoperable. [3][4][5]9,11,12,[14][15][16]19,21,[23][24][25][26]37,38,40,44,62,64,65,70,73,75,79,86 The brainstem surface, when near to or accessed by the lesion, is the shortest and most direct path for surgical treatment. 3,5,9,14,21,64,75,79 Several safe entry zones have been proposed and used for lesions inside the brainstem. 3,5,9,12,13,23,24,40,65,86 To maximize the chances of safe and precise removal of these lesions, sufficient exposure of the brainstem surface is critical, as is selection of an appropriate entry corridor into the brainstem.Cerebral fissures, such as the sylvian fissure, are routinely opened in the supratentorial region to access deeply situated pathology without dividing any neural tissue. Fissure dissection has also been used in the infratentorial region. 22,49,53,60,61 Opening the arachnoid membranes and trabeculae along the cerebellar-brainstem fissures, as in the telovelar or transcerebellomedullary fissure approaches, was originally proposed to access the pineal region, cranial nerve (CN) V, and the fourth ventricle. 22,49,60 However, brainstem surgery frequently requires the opening of the 3 cerebellar-brainstem fissures and/or adjacent cerebellar fissures to expose the cerebellar peduncles and brainstem surface hidden by the parts of the cerebellum forming the walls of the 3 cerebellar-brainstem fissures.61,71 Most of the major cerebellar arteries, veins, and vital neural structures, including a majority of the CNs and all 3 cerebellar peduncles, are located inside or close to these fissures. 27,43,45,56,66,68,85 Detailed knowledge of these fissures is abbreviatioNs AICA = anterior inferior cerebellar artery; CN = cranial nerve; PCA = posterior cerebral artery; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery. obJective Fissure dissection is routinely used in the supratentorial region to access deeply situated pathology while minimizing division of neural tissue. Use of fissure dissection is also practical in the posterior fossa. In this study, the microsurgical anatomy of the 3 cerebellar-brainstem fissures (cerebellomesencephalic, cerebellopontine, and cerebellomedullary) and the various procedures exposing these fissures in brainstem surgery were examined. methods Seven cadaveric heads were examined with a microsurgical technique and 3 with fiber dissection to clarify the anatomy of the cerebellar-brainstem and adjacent cerebellar fissures, in which the major vessels and neural structures are located. Several approaches directed along the cerebellar surfaces and fissures, including the supracerebellar infratentorial, occipital transtentorial, retrosigmoid, and midline suboccipital approaches, were examined. The 3 heads examined using fiber dissection defined the anatomy of the cerebellar peduncles coursing in the depths of these fissures. results Dissections dir...

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“…It also provides a favorable direct trajectory to the AVM and the superior cerebellar artery feeders in the quadrigeminal cistern, as well as control of the draining vein going into the vein of Galen. [4][5][6] 2:03 Lateral Position and Skin Incision. The patient is placed in the lateral position with the right side down to allow gravity-assisted access to the interhemispheric fissure without fixed retraction.…”

Section: Transcriptmentioning

confidence: 99%

Endoscopic-assisted parieto-occipital interhemispheric precuneal transtentorial approach for microsurgical resection of vermian arteriovenous malformation: operative video and technical nuances

Zhao¹,

Quillin²,

Liu³

2021

Neurosurgical Focus: Video

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In this illustrative video, the authors demonstrate resection of a superior vermian arteriovenous malformation (AVM) using the endoscopic-assisted parieto-occipital interhemispheric precuneal transtentorial approach. Lateral positioning allows for gravity-assisted access to the interhemispheric fissure without retractors. The parieto-occipital trajectory is useful in patients who have a steep tentorial angle and avoids manipulation of the occipital lobe and visual cortex. In addition, the authors utilize an angled endoscope, which allows full inspection of the resection bed after AVM removal to visualize areas hidden from the microsurgical view to minimize the chance of residual disease in a deep corridor with multiple visual obstructions.The video can be found here: https://youtu.be/hk9nIIdtqbI

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The Occipital Interhemispheric Transtentorial Approach for Superior Vermian, Superomedian Cerebellar, and Tectal Arteriovenous Malformations: Advantages, Limitations, and Alternatives

Cited by 19 publications

References 22 publications

Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study

Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study

Anatomy and approaches along the cerebellar-brainstem fissures

Endoscopic-assisted parieto-occipital interhemispheric precuneal transtentorial approach for microsurgical resection of vermian arteriovenous malformation: operative video and technical nuances

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