• World Neurosurg · Feb 2019

    Case Reports Comparative Study

    Quantitative endoscopic comparison of contralateral interhemispheric transprecuneus and transtentorial transcollateral sulcus approaches to the atrium.

    • Xiaochun Zhao, Borba Moreira Leandro L Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Claudio Cavallo, Evgenii Belykh, Sirin Gandhi, Mohamed A Labib, Tayebi Meybodi Ali A Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Celene B Mulholland, Brandon D Liebelt, Michaela Lee, Peter Nakaji, and Mark C Preul.
    • Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
    • World Neurosurg. 2019 Feb 1; 122: e215-e225.

    ObjectiveThe contralateral interhemispheric transprecuneus approach (CITP) and the supracerebellar transtentorial transcollateral sulcus approach (STTC) are 2 novel approaches to access the atrium of the lateral ventricle. We quantitatively compared the 2 approaches.MethodsBoth approaches were performed in 6 sides of fixed and color-injected cadaver heads. We predefined the 6 targets in the atrium for measurement and standardization of the approaches. Using a navigation system, we quantitatively measured the working distance, cortical transgression, angle of attack, area of exposure, and surgical freedom.ResultsThe distances from the craniotomy edge to the posterior pole of the choroid plexus of the CITP (mean ± standard deviation, 67 ± 5.3 mm) and STTC (mean, 57 ± 4.0 mm) differed significantly (P < 0.01). Cortical transgression with the CITP (mean, 27 ± 2.8 mm) was significantly greater than that with the STTC (mean, 21 ± 6.7 mm; P = 0.03). The CITP showed a significantly wider rostrocaudal angle of attack than that with the STTC (P = 0.01). The STTC showed a significantly wider mediolateral angle (P < 0.01). No significant difference was found for surgical freedom of any target except for point E, for which the CITP was larger. The exposure area did not differ significantly between the 2 approaches (P = 0.07).ConclusionsBoth approaches were feasible for accessing the atrium. The STTC provided a shorter working distance and wider mediolateral angle, CITP provided a wider rostrocaudal angle of attack and better exposure and maneuverability to the anterior and superior atrium. In contrast, the STTC was more favorable for the inferior and posterior regions.Copyright © 2018 Elsevier Inc. All rights reserved.

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