Üçüncü ventriküle anterior interhemisferik transkallozal yaklaşım yoluyla anterior komissürün mikrocerrahi anatomisi: Anatomik ve morfolojik bir çalışma

Abstract

Amaç: Üçüncü ventrikül, huni şeklinde derin yerleşimli bir beyin boşluğudur ve cerrahi yaklaşımlarla ulaşılması güçtür. Anterior komissür üçüncü ventrikülün anterior duvarında lokalize anatomik bir yapıdır. Bu çalışmada, üçüncü ventriküle ulaşmak için uygulanan anterior interhemisferik transkallozal yaklaşımların gösterilmesi, anterior komissürün mikrocerrahi anatomisinin incelenmesi ve bu bölgenin morfolojik özelliklerini incelenmesi amaçlanmıştır. Yöntemler: 11 kadaverik beyin spesimeni mikrocerrahi aletlar kullanılarak diseke edildi. Üçüncü ventriküle ulaşmak için farklı anterior interhemisferik yollar gösterildi ve anterior komissürün bacaklarını ortaya koymak için kademeli diseksiyonlar yapıldı. Anterior komissür ve üçüncü ventrikülün morfolojik hesaplamaları yapıldı. Bulgular: Anterior komissürün anterior bacağı, anterior perforan maddeye, olfaktör bulba, anterior olfaktör nükleusa ve orbitofrontal kortekse doğru uzanmaktadır. Posterior bacağı ise, kaudat nükleusun bazal kısmından uzanarak substansiya innominatanın altından geçmekte ve putamenin bazal kısmına doğru seyretmektedir. Anterior komissürün posterior bacağı, anterior komissürün majör komponentini oluşturmaktadır, ve temporal ve oksipital loblara giden liflerden oluşmaktadır. Anterior komissür gövdesinin ortalama uzunluğu 16,2 ± 4,2 (Aralık 9,7-24,2) mm, ve ortalama eni ise 4,3 ± 0,7 (Aralık 2,8-5,1) mm idi. Sonuç: Üçüncü ventrikülün ve anterior komissürün mikrocerrahi anatomisi ve morfometrik özelliklerinin daha iyi anlaşılması bu bölgeye yapılacak cerrahi girişimlerde başarılı olmayı sağlar ve olası komplikasyonları önler.

Keywords

• Üçüncü ventrikül
• Anterior interhemisferik transkallozal yaklaşım
• Anterior komissür
• Mikrocerrahi anatomi

Microsurgical anatomy of the anterior commissure through the anterior interhemispheric transcallosal approach to the third ventricle: An anatomical and morphological study

Abstract

Aim: The third ventricle is a funnel-shaped cavity located deep in the brain and difficult to access with surgical approach. The anterior commissure is an anatomical structure located on the anterior wall of the third ventricle. This study aimed to demonstrate the use of the anterior interhemispheric transcallosal approaches to access the third ventricle, evaluate the microsurgical anatomy of the anterior commissure and investigate the morphological features of this region. Methods: Eleven cadaveric brain specimens were dissected using microsurgical tools. Different anterior interhemispheric routes to the third ventricle were demonstrated, and stepwise dissections were performed to expose the limbs of the anterior commissure. Morphological measurements of the anterior commissure and the third ventricle were carried out. Results: The anterior limb of the anterior commissure extends towards the anterior perforating substance, olfactory bulb, anterior olfactory nucleus and the orbitofrontal cortex. The posterior limb extends from the basal part of the caudate nucleus, passes below the substantia innominata and courses through the basal part of the putamen. It constitutes the major component of the anterior commissure and is composed of temporal and occipital fibers. The mean length of the anterior commissure body was 16.2 ± 4.2 (range 9.7–24.2) mm, while the mean width was 4.3 ± 0.7 (range 2.8–5.1) mm. Conclusion: A better understanding of the microsurgical anatomy and morphometric features of the third ventricle and anterior commissure increases the success of surgical interventions and prevents possible complications in this region.

Keywords

• Third ventricle
• Anterior interhemispheric transcallosal approach
• Anterior commissure
• Microsurgical anatomy

References

1. 1. Rhoton AL Jr. The lateral and third ventricles. Neurosurgery. 2002 51[Suppl1]:207–71.
2. 2. Hernesniemi J, Romani R, Dashti R, Albayrak BS, Savolainen S, Ramsey C 3rd, et al. Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach--experience of 134 patients. Surg Neurol. 2008 May;69(5):447-53; discussion 453-6.
3. 3. Delfini R, Pichierri A. Transcallosal Approaches to Intraventricular Tumors. In: Cappabianca P, Iaconetta G, Califano L, eds. Cranial, Craniofacial and Skull Base Surgery. Milano: Springer; 2010. Pp.87-105.
4. 4. Ribas EC, Yağmurlu K, de Oliveira E, Ribas GC, Rhoton A. Microsurgical anatomy of the central core of the brain. J Neurosurg. 2018 Sep;129(3):752-69.
5. 5. Antunes JL, Louis KM, Ganti SR. Colloid cysts of the third ventricle. Neurosurgery. 1980 7:450-5.
6. 6. Symss NP, Ramamurthi R, Rao SM, Vasudevan MC, Jain PK, Pande A. Management outcome of the transcallosal, transforaminal approach to colloid cysts of the anterior third ventricle: an analysis of 78 cases. Neurol India. 2011 Jul-Aug;59(4):542-7.
7. 7. Lavrador JP, Ferreira V, Lourenço M, Alexandre I, Rocha M, Oliveira E, et al. White-matter commissures: a clinically focused anatomical review. Surg Radiol Anat. 2019;41:613–24.
8. 8. Ozer MA, Kayalioglu G, Erturk M. Morphometric anatomy of anterior commissure, pineal body and massa intermedia. Medeniyet Med J. 2005;20(3):161-3.

9. 9. Erturk M, Kayalioglu G, Ozer MA. Morphometry of the anterior third ventricle region as a guide fort he subfrontal (translaminaterminalis) approach. Neurosurg Rev. 2003 Oct;26(4):249-52.
10. 10. Damle NR, Ikuta T, John M, Peters BD, DeRosse P, Malhotra AK, et al. Relationship among interthalamic adhesion size, thalamic anatomy and neuropsychological functions in healthy volunteers. Brain Struct Funct. 2017;222(5):2183-92.
11. 11. Carpenter MB, Sutin J, editors. Human neuroanatomy, 8th ed. Baltimore: Williams & Wilkins; 1983.
12. 12. Borghei A, Cothran T, Brahimaj B, Sani S. Role of massa intermedia in human neurocognitive processing. Brain Struct Funct. 2020;225:985–93.
13. 13. Absher JR, Benson DF. Disconnection syndromes: an overview of Geschwind’s contributions. Neurology 1993;43:862–7.
14. 14. Demeter S, Rosene DL, Van Hoesen GW. Fields of origin and pathways of the interhemispheric commissures in the temporal lobe of macaques. J Comp Neurol. 1990 Dec 1;302(1):29-53.
15. 15. Catani M, Howard RJ, Pajevic S, Jones DK. Virtual in vivo interactive dissection of white matter fasciculi in the human brain. Neuroimage. 2002 Sep;17(1):77-94.
16. 16. Catani M, ffytche DH. The rises and falls of disconnection syndromes. Brain. 2005 Oct;128(Pt 10):2224-39.
17. 17. Di Virgilio G, Clarke S, Pizzolato G, Schaffner T. Cortical regions contributing to the anterior commissure in man. Exp Brain Res. 1999 Jan;124(1):1-7.
18. 18. Patel MD, Toussaint N, Charles-Edwards GD, Lin JP, Batchelor PG. Distribution and fibre field similarity mapping of the human anterior commissure fibres by diffusion tensor imaging. MAGMA. 2010 Dec;23(5-6):399-408.
19. 19. Wilde EA, Bigler ED, Haider JM, Chu Z, Levin HS, Li X, Hunter JV. Vulnerability of the anterior commissure in moderate to severe pediatric traumatic brain injury. J Child Neurol. 2006 Sep;21(9):769-76.
20. 20. Highley JR, Esiri MM, McDonald B, Roberts HC, Walker MA, Crow TJ. The size and fiber composition of the anterior commissure with respect to gender and schizophrenia. Biol Psychiatry. 1999 May 1;45(9):1120-7.
21. 21. Mughal AA, Zhang L, Fayzullin A, Server A, Li Y, Wu Y, et al. Patterns of Invasive Growth in Malignant Gliomas-The Hippocampus Emerges as an Invasion-Spared Brain Region. Neoplasia. 2018 Jul;20(7):643-56.
22. 22. Fischer M, Ryan SB, Dobyns WB. Mechanisms of interhemispheric transfer and patterns of cognitive function in acallosal patients of normal intelligence. Arch Neurol. 1992;49(3):271–7.
23. 23. Peltier J, Verclytte S, Delmaire C, Pruvo JP, Havet E, Le Gars D. Microsurgical anatomy of the anterior commissure: Correlations with diffusion tensor imaging fiber tracking and clinical relevance. Neurosurgery. 2011;69:ons241–6.
24. 24. Botez-Marquard T, Botez MI. Visual memory deficits after damage to the anterior commissure and right fornix. Arch Neurol. 1992 Mar;49(3):321-4.
25. 25. Winter TJ, Franz EA. Implication of the anterior commissure in the allocation of attention to action. Front Psychol. 2014 May 19;5:432.
26. 26. Bermond B, Vorst HC, Moormann PP. Cognitive neuropsychology of alexithymia: implications for personality typology. Cogn Neuropsychiatry. 2006 May;11(3):332-60.
27. 27. Meza-Concha N, Arancibia M, Salas F, Behar R, Salas G, Silva H, et al. Towards a neurobiological understanding of alexithymia. Medwave. 2017 May 29;17(4):e6960.
28. 28. Duffau H. Brain Mapping: From Neural Basis of Cognition to Surgical Applications. Wien: Springer-Verlag; 2011.
29. 29. O'Reilly JX, Croxson PL, Jbabdi S, Sallet J, Noonan MP, Mars RB, et al. Causal effect of disconnection lesions on interhemispheric functional connectivity in rhesus monkeys. Proc Natl Acad Sci USA. 2013 Aug;110(34):13982-7.
30. 30. Lang J, Stefanec P, Breitenbach W. Form and measurements of the third ventricle, visual pathway sections and oculomotor nerve. Neurochirurgia (Stuttg). 1983 Jan;26(1):1-5.