The Superior Frontal Transsulcal Approach to the Anterior Ventricular System: Exploring the Sulcal and Subcortical Anatomy Using Anatomic Dissections and Diffusion Tensor Imaging Tractography

• Published in: World neurosurgery 2017-10, Vol.106, p.339-354
• Main Authors: Koutsarnakis, Christos, Liakos, Faidon, Kalyvas, Aristotelis V., Skandalakis, Georgios P., Komaitis, Spyros, Christidi, Fotini, Karavasilis, Efstratios, Liouta, Evangelia, Stranjalis, George
• Format: Article
• Language: English
• Subjects: Adult; Cadaver; Cerebral Ventricles - anatomy & histology; Cerebral Ventricles - diagnostic imaging; Corpus Callosum - anatomy & histology; Corpus Callosum - diagnostic imaging; Diffusion Tensor Imaging; DTI; External Capsule - anatomy & histology; External Capsule - diagnostic imaging; Frontal lobe; Frontal Lobe - anatomy & histology; Frontal Lobe - diagnostic imaging; Healthy Volunteers; Humans; Internal Capsule - anatomy & histology; Internal Capsule - diagnostic imaging; Magnetic Resonance Imaging; Prefrontal Cortex - anatomy & histology; Prefrontal Cortex - diagnostic imaging; Transsulcal approaches; Ventricular surgery; White Matter - anatomy & histology; White Matter - diagnostic imaging; White matter anatomy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.06.161

To explore the superior frontal sulcus (SFS) morphology, trajectory of the applied surgical corridor, and white matter bundles that are traversed during the superior frontal transsulcal transventricular approach. Twenty normal, adult, formalin-fixed cerebral hemispheres and 2 cadaveric heads were included in the study. The topography, morphology, and dimensions of the SFS were recorded in all specimens. Fourteen hemispheres were investigated through the fiber dissection technique whereas the remaining 6 were explored using coronal cuts. The cadaveric heads were used to perform the superior frontal transsulcal transventricular approach. In addition, 2 healthy volunteers underwent diffusion tensor imaging and tractography reconstruction studies. The SFS was interrupted in 40% of the specimens studied and was always parallel to the interhemispheric fissure. The proximal 5 cm of the SFS (starting from the SFS precentral sulcus meeting point) were found to overlie the anterior ventricular system in all hemispheres. Five discrete white matter layers were identified en route to the anterior ventricular system (i.e., the arcuate fibers, the frontal aslant tract, the external capsule, internal capsule, and the callosal radiations). Diffusion tensor imaging studies confirmed the fiber tract architecture. When feasible, the superior frontal transsulcal transventricular approach offers a safe and effective corridor to the anterior part of the lateral ventricle because it minimizes brain retraction and transgression and offers a wide and straightforward working corridor. Meticulous preoperative planning coupled with a sound microneurosurgical technique are prerequisites to perform the approach successfully.