Anterior peri-insular quadrantotomy: a cadaveric white matter dissection study
Por:
Gonzalez-Lopez, P, Cossu, G, Pralong, E, Baldoncini, M, Messerer, M and Daniel, R
Publicada:
1 abr 2020
Ahead of Print:
20 dic 2019
Resumen:
OBJECTIVE Anterior quadrant disconnection represents a safe surgical option in well-selected pediatric patients with a large frontal lobe lesion anterior to the motor cortex. The understanding of the anatomy of the white matter tracts connecting the frontal lobe with the rest of the cerebrum forms the basis of a safe and successful disconnective surgery. The authors explored and illustrated the relevant white matter tracts sectioned during each surgical step using fiber dissection techniques.
METHODS Five human cadaveric hemispheres were dissected to illustrate the frontal connections in the 3 planes. The dissections were performed from lateral to medial, medial to lateral, and ventral to dorsal to describe the various tracts sectioned during the 4 steps of this surgery, namely the anterior suprainsular window, intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection.
RESULTS At the beginning of each surgical step, the U fibers were cut. During the anterior suprainsular window, the superior longitudinal fasciculus (SLF), the uncinate fasciculus, and the inferior fronto-occipital fasciculus (IFOF) were visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. During the intrafrontal disconnection, the SLF was cut, along with the corona radiata. At the medial surface the cingulum was sectioned. The anterior callosotomy disconnected the anterior third of the body of the callosum, the genu, and the rostrum. The frontobasal disconnection addressed the last remaining fibers connecting the frontal lobe with the rest of the hemisphere, namely the anterior limb of the anterior commissure.
CONCLUSIONS The anterior peri insular quadrantotomy aims at effectively treating children with large lesions of the frontal lobe anterior to the motor cortex. A precise understanding of the gyral anatomy of this lobe along with the several white matter connections is crucial to avoid motor complications and to ensure complete disconnection.
Filiaciones:
:
Hosp Gen Univ Alicante, Dept Neurosurg, Alicante, Spain
Cossu, G:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Pralong, E:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Baldoncini, M:
San Fernando Hosp, Dept Neurol Surg, Buenos Aires, DF, Argentina
Messerer, M:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Univ Lausanne, Fac Med & Biol, Lausanne, Switzerland
Daniel, R:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Univ Lausanne, Fac Med & Biol, Lausanne, Switzerland
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