Surgical indications and microsurgical anatomy of the transchoroidal fissure approach for lesions in and around the ambient cistern

被引:51
作者
Ikeda, K
Shoin, K
Mohri, M
Kijima, T
Someya, S
Yamashita, J
机构
[1] Natl Kanazawa Hosp, Dept Neurosurg, Kanazawa, Ishikawa 9208650, Japan
[2] Ishikawa Prefectural Hosp, Dept Neurosurg, Kanazawa, Ishikawa 9208650, Japan
[3] Kanazawa Univ Hosp, Dept Neurosurg, Kanazawa, Ishikawa, Japan
关键词
ambient cistern; choroidal fissure; microsurgical anatomy; surgery;
D O I
10.1097/00006123-200205000-00030
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:1114 / 1119
页数:6
相关论文
共 25 条
[1]  
Drake C G, 1979, Clin Neurosurg, V26, P145
[2]   ANEURYSMS OF POSTERIOR CEREBRAL ARTERY [J].
DRAKE, CG ;
AMACHER, AL .
JOURNAL OF NEUROSURGERY, 1969, 30 (04) :468-&
[3]   NEUROSURGICAL TOPOGRAPHY OF THE OPTIC RADIATION IN THE TEMPORAL-LOBE [J].
EBELING, U ;
REULEN, HJ .
ACTA NEUROCHIRURGICA, 1988, 92 (1-4) :29-36
[4]  
EHNI G, 1987, SURG 3 VENTRICLE, P326
[5]   VISUAL FIELD CHANGES FOLLOWING ANTERIOR TEMPORAL LOBECTOMY - THEIR SIGNIFICANCE IN RELATION TO MEYER LOOP OF THE OPTIC RADIATION [J].
FALCONER, MA ;
WILSON, JL .
BRAIN, 1958, 81 (01) :1-14
[6]   ZYGOMATIC APPROACH FOR LESIONS IN THE INTERPEDUNCULAR CISTERN [J].
FUJITSU, K ;
KUWABARA, T .
JOURNAL OF NEUROSURGERY, 1985, 62 (03) :340-343
[7]  
GARRETSON HD, 1987, SURG 3 VENTRICLE, P209
[8]   AN ALTERNATIVE SURGICAL APPROACH TO ANEURYSMS OF THE POSTERIOR CEREBRAL-ARTERY [J].
GERBER, CJ ;
NEILDWYER, G ;
EVANS, BT ;
HAMILTON, MG ;
WASCHER, TM ;
SPETZLER, RF ;
ELLER, TW .
NEUROSURGERY, 1993, 32 (06) :928-931
[9]   ARTERIOVENOUS-MALFORMATIONS OF THE MEDIAL TEMPORAL-LOBE - SURGICAL APPROACH AND NEURORADIOLOGICAL CHARACTERIZATION [J].
HEROS, RC .
JOURNAL OF NEUROSURGERY, 1982, 56 (01) :44-52
[10]  
IKEDA K, 1995, SURG CEREB STROKE, V23, P139