• Issa Ali Muftah Lahirish, Erik H Middlebrooks, Vanessa Milanesi Holanda, Ruben Batista-Quintero, Fernando Luís Maeda, Mateus Reghin Neto, Richard Gonzalo Parraga, and Evandro de Olivieira.
• Institute of Neurological Sciences (ICNE), São Paulo, Bela Vista, São Paulo, Brazil; Evandro de Oliveira Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil. Electronic address: issalaharish@yahoo.com.
• World Neurosurg. 2020 Jun 1; 138: e478-e485.

ObjectiveThe objective of this study was to compare transcortical and posterior interhemispheric approaches to the atrium using a combined approach of white matter fiber dissections and magnetic resonance (MR) tractography.MethodsTen cerebral hemispheres were examined and dissected from the lateral-to-medial surface and from the medial-to-lateral surface, with special attention to the white matter tracts related to the atrium. MR tractography was used to show the relationship of three-dimensional white matter fibers with the atrium of the lateral ventricle and to compare with cadaveric dissection results.ResultsThe atrium was related laterally to the superior longitudinal fasciculus II and III, middle longitudinal fasciculus, arcuate fasciculus, vertical occipital fasciculus, and sagittal stratum. Medially, it is related to the superior longitudinal fasciculus I, cingulum, sledge runner, and forceps major.ConclusionsA combined approach of cadaveric white matter fiber dissections and MR tractography were used to describe the main white matter tracts related to the posterior interhemispheric approach and the transcortical approach, providing an in-depth understanding of the three-dimensional anatomy of white matter fibers and the atrium. In the present study, among approaches examined, the posterior interhemispheric parasplenial transprecuneus approach placed fewer eloquent tracts at risk; however, traversing the sledge runner and the forceps major is unavoidable by this approach.Copyright © 2020 Elsevier Inc. All rights reserved.

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