• Christos Koutsarnakis, Faidon Liakos, Aristotelis V Kalyvas, Georgios P Skandalakis, Spyros Komaitis, Fotini Christidi, Efstratios Karavasilis, Evangelia Liouta, and George Stranjalis.
• Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Clinical Neuroscience, Western General Hospital, Edinburgh, United Kingdom. Electronic address: ckouts@hotmail.co.uk.
• World Neurosurg. 2017 Oct 1; 106: 339-354.

ObjectiveTo explore the superior frontal sulcus (SFS) morphology, trajectory of the applied surgical corridor, and white matter bundles that are traversed during the superior frontal transsulcal transventricular approach.MethodsTwenty normal, adult, formalin-fixed cerebral hemispheres and 2 cadaveric heads were included in the study. The topography, morphology, and dimensions of the SFS were recorded in all specimens. Fourteen hemispheres were investigated through the fiber dissection technique whereas the remaining 6 were explored using coronal cuts. The cadaveric heads were used to perform the superior frontal transsulcal transventricular approach. In addition, 2 healthy volunteers underwent diffusion tensor imaging and tractography reconstruction studies.ResultsThe SFS was interrupted in 40% of the specimens studied and was always parallel to the interhemispheric fissure. The proximal 5 cm of the SFS (starting from the SFS precentral sulcus meeting point) were found to overlie the anterior ventricular system in all hemispheres. Five discrete white matter layers were identified en route to the anterior ventricular system (i.e., the arcuate fibers, the frontal aslant tract, the external capsule, internal capsule, and the callosal radiations). Diffusion tensor imaging studies confirmed the fiber tract architecture.ConclusionsWhen feasible, the superior frontal transsulcal transventricular approach offers a safe and effective corridor to the anterior part of the lateral ventricle because it minimizes brain retraction and transgression and offers a wide and straightforward working corridor. Meticulous preoperative planning coupled with a sound microneurosurgical technique are prerequisites to perform the approach successfully.Copyright © 2017 Elsevier Inc. All rights reserved.

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