• Pedro Roldan, Giulia Guizzardi, Alberto Di Somma, Rene Valera, Federico Varriano, Antonio Donaire, Jhon Hoyos, Thomaz E Topczewski, Jorge Torales, Joaquim Enseñat, Jordi Rumia, and Alberto Prats-Galino.
• Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.
• World Neurosurg. 2022 Aug 1; 164: e755-e763.

BackgroundEpilepsy surgery has an important role in the treatment of patients with medically intractable seizures. Various authors have proposed an endoscopic technique to perform disconnective procedures. A detailed description of intracerebral anatomy seen through an endoscopic transcallosal corridor has not been reported. The aim of this study was to present a cadaveric step-by-step anatomical demonstration of endoscopic transcallosal hemispherotomy using a dedicated three-dimensional model.MethodsAnatomical dissections were performed on 6 cadaveric heads (12 hemispheres), and the disconnective procedure was performed using an endoscopic transcallosal approach. A dedicated three-dimensional model was used to better illustrate each step. A simulation of the disconnective procedure was performed by recreating the surgical steps on a subject from the Human Connectome Project dataset, and a calculation of the fiber tracts intersected was performed.ResultsAnalyzing data extracted from the three-dimensional model and tractography simulation, 100% of the fibers (streamlines) of corpus callosum, corticopontine tracts, corticospinal tract, and inferior fronto-occipital fascicle were transected. Moreover, a satisfactory number of fibers (>95%) of the thalamocortical tracts, corticostriatal tracts, corona radiata, fornix, and uncinate fascicle were disconnected.ConclusionsThis anatomical study described the relevant neurovascular structures to enable prediction of feasibility and control of the surgical procedure using the endoscopic transcallosal approach. The quantitative analysis permitted estimation of the theoretical efficacy of the procedure, confirming its relevant role in disconnective surgery.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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