• World Neurosurg · Dec 2018

    Anatomic Understanding of Posterior Quadrant Disconnection from Cadaveric Brain, 3D Reconstruction and Simulation Model, and Intraoperative Photographs.

    • Ryoko Umaba, Takehiro Uda, Kosuke Nakajo, Toshiyuki Kawashima, Yuta Tanoue, Saya Koh, Hiroshi Uda, Noritsugu Kunihiro, Yasuhiro Matsusaka, and Kenji Ohata.
    • Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
    • World Neurosurg. 2018 Dec 1; 120: e792-e801.

    BackgroundPosterior quadrant disconnection is a surgery for refractory unilateral temporoparieto-occipital epilepsy to limit propagation of epileptic discharges. As incomplete disconnection can lead to residual seizures, detailed procedures are presented using a cadaveric brain, three-dimensional (3D) reconstruction and simulation models, and intraoperative photographs.MethodsA formalin-fixed adult cadaveric brain was dissected to show each step in posterior quadrant disconnection. Using 3D preoperative planning software, we reconstructed 3D models of operative views from computed tomography and magnetic resonance imaging. Intraoperative photographs were taken from the case of a 7-year-old girl with temporoparieto-occipital epilepsy.ResultsFrontotemporoparietal craniotomy was performed. The Sylvian fissure was widely dissected, and the insular cortex was exposed. The temporal stem was disconnected along the inferior peri-insular sulcus. The disconnection was extended from the limen insulae to the atrium of the lateral ventricle. The fibers between the head of the hippocampus and the amygdala were disconnected. The parietal lobe was disconnected along the postcentral sulcus, and the disconnection was connected to the atrium of the lateral ventricle. At the medial surface of the parietal lobe, the disconnection was continued to the corpus callosum. The splenium of the corpus callosum was disconnected via the medial wall of the lateral ventricle. The fornix was divided in the atrium of the lateral ventricle. After these steps, disconnection of the unilateral tempoparieto-occipital lobe was achieved while preserving the arteries and veins.ConclusionsInclusion of views from cadaveric brain, 3D reconstruction and simulation models, and intraoperative photographs facilitates a clearer anatomic understanding of posterior quadrant disconnection.Copyright © 2018 Elsevier Inc. All rights reserved.

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