• Pau Capilla-Guasch, Vicent Quilis-Quesada, Mateus Regin-Neto, Vanessa M Holanda, José M González-Darder, and Evandro de Oliveira.
• Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain; Department of Anatomy and Human Embriology, Microneurosurgery Laboratory, University of Valencia, Valencia, Spain. Electronic address: paucg89@hotmail.com.
• World Neurosurg. 2019 Dec 1; 132: e783-e794.

BackgroundNumerous lesions are found in the ventricular atrium (VA). Access is gained through many white matter tracts with great relevance and specific neurologic functions. It is important to understand the configuration of the most relevant structures surrounding this zone and, thus, select the safest entry zone on the lateral cerebral surface.ObjectiveWe studied the white matter layers traversed in the lateral transcortical parietal approach through the intraparietal sulcus (IPS), adding a transillumination technique. With this knowledge, we selected the safest highway to improve this particular approach.MethodsAn in-depth study of the white matter tracts was performed on 24 cerebral hemispheres (12 human whole brains). The Klingler technique and microsurgical dissection techniques were used under ×6 to ×40 magnification. The transillumination technique (torch illuminating the ventricular cavity) was used to expose the layers surrounding the VA and, thus, guide the dissection.ResultsTaking the IPS on the cerebral surface as a reference, we identified the following white matter layers ordered from the surface to the ependyma: U fibers, superior longitudinal fascicle, arcuate fascicle, vertical occipital fascicle, sagittal stratum with the optic radiations, and tapetum fibers. The transillumination technique allowed for the easier identification of the white matter deep periventricular layers.ConclusionsKnowledge of the main fascicles in the path and neighborhood of the VA allowed us to understand how certain neurologic functions can be affected by lesions at this level and to select the most appropriate way to avoid damaging relevant fascicles.Copyright © 2019 Elsevier Inc. All rights reserved.

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