Sugita–Kobayashi Maneuver for Preservation of Large Bridging Veins in the Interhemispheric Approach: 2-Dimensional Operative Video

✓ Postoperative venous infarction following aneurysm surgery was studied in 48 patients with anterior communicating artery aneurysms operated on through the interhemispheric approach at the acute stage of subarachnoid hemorrhage (SAH). Of 23 patients whose bridging veins were sacrificed during surgery, 11 (47.8%) showed venous infarction in the frontal lobes. In contrast, only one (5.9%) of 17 patients whose bridging veins were preserved developed cerebral edema. None of eight patients who were operated on after Day 11 (the day of SAH was defined as Day 0) showed this complication, although bridging veins were sacrificed in six of them. Venous infarction following acute aneurysm surgery tended to occur more frequently in patients of higher SAH grade and/or more advanced age, but these correlations were not significant. However, the correlation between the sacrifice of veins and venous infarction was significant (p < 0.025). Because this potential complication may compromise the benefit of acute aneurysm surgery and cause damage, it is important to preserve the venous system and in some instances to select another surgical approach based on the pattern of venous drainage in the frontal lobe.

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Anterior Interhemispheric Approach for 100 Tumors in and Around the Anterior Third Ventricle

Operative Neurosurgery ◽

10.1227/01.neu.0000365550.84124.bb ◽

2010 ◽

Vol 66 (suppl_1) ◽

pp. ons-65-ons-74 ◽

Cited By ~ 4

Author(s):

Tomokatsu Hori ◽

Takakazu Kawamata ◽

Kosaku Amano ◽

Yasuo Aihara ◽

Masami Ono ◽

...

Keyword(s):

Third Ventricle ◽

Karnofsky Performance Scale ◽

Subtotal Resection ◽

Anterior Communicating Artery ◽

Lamina Terminalis ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach ◽

Bridging Veins ◽

Performance Scale

Abstract Objective: We report our experience with anterior interhemispheric approach for tumors in and around the anterior third ventricle, including surgical technique, instrumentation, pre- and postoperative hormonal disturbances, and resection rate. Methods: One hundred patients with 46 craniopharyngiomas, 12 hypothalamic gliomas, 12 meningiomas, 6 hypothalamic hamartomas, and 24 other lesions were operated on using an anterior interhemispheric approach with or without opening of the lamina terminalis. This surgical approach involves no frontal sinus opening; a narrow (approximately 15–20 mm in width) access between the bridging veins, which is sufficient to remove the tumor totally; and sparing of the anterior communicating artery. Specially designed long bipolar forceps and scissors are necessary for this approach, and concomitant use of angled instruments (endoscope, aspirator, and microforceps) is required frequently. The postsurgical follow-up period varied from 4 months to 18 years. Results: Total removal of the neoplasm was accomplished in 37 of 46 patients with craniopharyngiomas (80.4%), whereas subtotal resection was performed in hypothalamic gliomas. No significant differences in pre- and postoperative hormonal disturbances were observed in 37 craniopharyngiomas and 10 hypothalamic gliomas. There was no operative mortality. Visual acuity was preserved or improved in 68 of 75 patients assessed. The Karnofsky Performance Scale score did not deteriorate in 72 of 75 patients tested. Conclusion: The minimally invasive anterior interhemispheric approach, with or without opening of the lamina terminalis, is useful for removal of tumors in and around the anterior third ventricle, such as craniopharyngiomas and hypothalamic gliomas.

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Surgical Techniques to Preserve the Bridging Veins in Interhemispheric Approach(Interhemispheric Approach)

Japanese Journal of Neurosurgery ◽

10.7887/jcns.1.196 ◽

1992 ◽

Vol 1 (3) ◽

pp. 196-200 ◽

Cited By ~ 1

Author(s):

Takeshi Sampei ◽

Nobuyuki Yasui

Keyword(s):

Surgical Techniques ◽

Interhemispheric Approach ◽

Bridging Veins

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Bifrontal basal interhemispheric approach to craniopharyngioma resection with or without division of the anterior communicating artery

Journal of Neurosurgery ◽

10.3171/jns.1996.84.6.0951 ◽

1996 ◽

Vol 84 (6) ◽

pp. 951-956 ◽

Cited By ~ 55

Author(s):

Masato Shibuya ◽

Masakazu Takayasu ◽

Yoshio Suzuki ◽

Kiyoshi Saito ◽

Kenichiro Sugita

Keyword(s):

Late Complications ◽

Pituitary Stalk ◽

Anterior Communicating Artery ◽

Operative Field ◽

Content Type ◽

Visual Improvement ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach ◽

Bridging Veins ◽

Perforating Arteries

✓ The authors describe the use of a bifrontal basal interhemispheric approach with or without division of the anterior communicating artery (ACoA) for removal of large craniopharyngiomas. This approach is a more basal modification of the anterior interhemispheric approach, allowing preservation of most bridging veins. Since 1988, 22 patients underwent operations using this approach to achieve total or near-total excision of large craniopharyngiomas. Division of the ACoA was performed in 11 of 17 patients with retrochiasmatic tumors with no early or late complications related to division of the artery. There were no operative mortalities. Visual improvement (59%) and preservation of the pituitary stalk (64%) were achieved in a high percentage of patients. Preservation of the pituitary stalk correlated well with postoperative pituitary function. The bifrontal basal interhemispheric approach allowed a bilateral, wider operative field with better orientation and views of important neural structures and perforating arteries without requiring combination with other approaches. When the ACoA limited operative exposure, the artery could be divided safely. The authors discuss indications for, and advantages of, the bifrontal basal interhemispheric approach with or without division of the ACoA in the removal of large craniopharyngiomas.

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Distal Anterior Cerebral Artery Aneurysms: Advantages of Bifrontal Basal Anterior Interhemispheric Approach Over Unilateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336206 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Rajesh Chhabra ◽

Sunil Gupta ◽

Sandeep Mohindra ◽

N. Khandelwal

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Unilateral Approach ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach ◽

Distal Anterior Cerebral Artery

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Pterional Approach for Surgical Treatment of Olfactory Groove Meningiomas

Neurosurgery ◽

10.1227/00006123-198912000-00014 ◽

1989 ◽

Vol 25 (6) ◽

pp. 942-947 ◽

Cited By ~ 50

Author(s):

W. Hassler ◽

J. Zentner

Keyword(s):

Surgical Treatment ◽

Superior Sagittal Sinus ◽

Cerebrospinal Fluid Fistula ◽

Pterional Approach ◽

Olfactory Groove ◽

Sagittal Sinus ◽

Frontal Brain ◽

Bridging Veins ◽

Frontal Sinuses ◽

Fluid Fistula

Abstract We present our experience with the surgical treatment of olfactory groove meningiomas using a pterional approach. This approach provides the advantages of previous techniques, such as preserving the frontal brain and superior sagittal sinus, early devascularization of the tumor, and late dissection of tumor borders. Moreover, it also compensates for the shortcomings of other techniques, e.g., compression of frontal bridging veins, late dissection of dorsal tumor aspects involving vessels and optic nerves as well as facultative infection and cerebrospinal fluid fistula-related complications caused by opening of frontal sinuses. To date, 11 patients were treated in this way. As we encountered no surgical complications in our series we are encouraged to present our procedure.

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