Surgical Anatomy of Supratentorial Midline Lesions

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20. Marino R Jr: The anterior cerebral artery: I-Anatomo-radiological study of its cortical territories. Surg Neurol 5:81-87, 1976. Bibliographic Links Document Delivery Library Holdings [Context Link] 21. Milhorat TH, Baldwin M: A technique for surgical exposure of the cerebral midline: Experimental transcallosal microdissection.J Neurosurg 24:687-691, 1966. Bibliographic Links Document Delivery Library Holdings [Context Link] 22. Milisavljevic S, Marinkovic S, Lolic-Draganic V, Djordjevic L: Anastomoses in the territory of the posterior cerebral arteries.Acta Anat 127:221-225, 1986. Bibliographic Links Document Delivery Library Holdings [Context Link] 23. Perlmutter D, Rhoton AL Jr: Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45:259-272, 1976. [Context Link] 24. Perlmutter D, Rhoton AL Jr: Microsurgical anatomy of the distal anterior cerebral artery. J Neurosurg 49:204-228, 1978. [Context Link] 25. Rhoton AL Jr, Yamamoto I, Peace DA: Microsurgery of the third ventricle: Part 2-Operative approaches. Neurosurgery 8:357-373, 1981. Bibliographic Links Document Delivery Library Holdings [Context Link] 26. Ring BA, Waddington MM: Roentgenographic anatomy of the pericallosal arteries. Am J Roentgenol 104:109-118, 1968. [Context Link] 27. Salamon G, Huang YP: Radiologic Anatomy of the Brain. New York, Springer-Verlag, 1976. [Context Link] 28. Timurkaynak E, Rhoton AL Jr, Barry M: Microsurgical anatomy and operative approaches to the lateral ventricles.Neurosurgery 19:685-723, 1986. Bibliographic Links Document Delivery Library Holdings [Context Link] 29. Vincentelli F, Lehman G, Caruso G, Grisoli F, Rabehanta B, Gouaze A: Extracerebral course of the perforating branches of the anterior communicating artery: Microsurgical anatomical study. Surg Neurol 35:98-104, 1991. Bibliographic Links Document Delivery Library Holdings [Context Link] 30. Williams PL: Nervous system, in Gray's Anatomy. New York, Churchill-Livingstone, 1995, ed 38, pp 901-1397. [Context Link] 31. Wolfram-Gabel R, Maillot C, Koritke JG: Vascularisation arterielle du corps calleux chez l'homme. Arch Anat Histol Embryol 72:43-55, 1989. Bibliographic Links Document Delivery Library Holdings [Context Link] 32. Yamamoto I, Kageyama N: Microsurgical anatomy of the pineal region. J Neurosurg 53:205-221, 1980. [Context Link] 33. Yamamoto I, Rhoton AL Jr, Peace DA: Microsurgery of the third ventricle: Part I-Microsurgical anatomy. Neurosurgery 8:334-356, 1981. [Context Link] 34. Yasargil MG: Operative anatomy, inMicroneurosurgery. Stuttgart, Georg Thieme Verlag, 1984, vol 1, pp 5-168. [Context Link] 35. Yasargil MG: Intrinsic tumors: Topographical aspects, inMicroneurosurgery. Stuttgart, Georg Thieme Verlag, 1996, vol 4B, pp 237-342. [Context Link] 36. Zeal AA, Rhoton AL Jr: Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48:534-559, 1978. Bibliographic Links Document Delivery Library Holdings [Context Link] COMMENTS The authors have completed an excellent study of the arteries of the corpus callosum, which is further enhanced by the illustrations. The anatomy described here will be useful in operative approaches directed along the whole medial surface of the hemisphere from the subfrontal area all the way back to the occipital region. The authors have provided an especially clear description of the perforating arteries arising from the anterior communicating artery (ACoA). These studies document that it is best to direct transcallosal approaches between the pericallosal arteries rather than on the lateral side of the arteries, which will lead to interruption of branches of the callosal arteries. Albert L. Rhoton, Jr. Gainesville, Florida The authors dissect 20 brains with injected arteries and study and measure the larger and smaller arteries to the corpus callosum and surrounding structures. Many of the measurements and descriptions have also been described in different articles from our Institute. I compare the results of both study groups and give some examples. In the material of Türe et al., the distance measured between the ACoA and the lamina terminalis is 4 mm (range, 1-9 mm); in our material it is 4.9 mm (range, 0-10 mm). Türe et al. found 2.5 (range, 1-6) perforating branches of the ACoA; we found 3 (range, 0-10). The diameters were measured by Türe et al., together with arteries to the corpus callosum; in our material, the measurements were taken only to the
diencephalon. For this group, the two arteries have nearly the same diameters. The subcallosal artery is newly described and was found in 50% of the specimens, and the median callosal artery was found in 30% of the specimens. Türe et al. identified both arteries much more often than did other researchers. The course of the ascending (subcallosal) segment of the pericallosal artery was described in both cases as S shaped, similar to the description given by Lang and Häckel. The width of this segment was approximately 2.5 mm. The course of the pericallosal arteries in the A3 to the A5 segment was seen in the callosal sulcus in 60% of the specimens. They described also that the artery runs at least partly into the cingulate sulcus in 32.5% of the specimens, and in approximately 10%, the midline crosses and runs into the opposite hemisphere.(This has also been seen in dissections by other researchers.) A good description is given of the posterior pericallosal artery and the branches of the pericallosal artery to the corpus callosum. In our study, this small branch has a width of 0.36 mm (range, 0.2-0.8 mm). Its origin was found to be the parieto-occipital artery in approximately 41% of our specimens and in 52% of Türe et al.'s specimens; it originated from the medial-occipital artery in approximately 37% of our specimens and from the P3 segment. In Türe et al.'s study, it originated from the calcarine artery in 7% and in our study in 10.3% of specimens. We also found the origin from the lateral occipital artery, from the anterior cerebral artery, from the posterior medial choroidal branch, and from the inferior temporal branch. We described anastomoses and some other variations. A very subtle microanatomy is described by Türe et al., the course and the branches of this small artery, which can be important during supra- or infratentorial approaches to the area of the splenium of the corpus callosum. The photographs of the work are excellent, the drawings easy to understand. Johannes Lang Würzburg, Germany Key words: Corpus callosum; Median callosal artery; Microsurgical anatomy; Pericallosal artery; Pericallosal pial plexus; Posterior pericallosal artery; Subcallosal artery Accession Number: 00006123-199612000-00001 Copyright (c) 2000-2005 Ovid Technologies, Inc. Version: rel10.2.0, SourceID 1.11354.1.65
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After cutting through the medial po
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Figure 3. Case 1. A-C: Preoperative
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Figure 5. Case 3. A-C: Preoperative
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Page 45 and 46: adjacent territories. This occurs v
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Page 57 and 58: DISCUSSION The fibers of the corpus
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Page 73: Arteries of the insula 17. Penfield
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Surgical Anatomy of Supratentorial Midline Lesions

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