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

Öz

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.

Anahtar Kelimeler

• 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

Kaynakça

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