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

1996 ◽  
Vol 84 (6) ◽  
pp. 951-956 ◽  
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.

Vascular anomalies associated with aneurysms of the anterior communicating artery: microsurgical observations

1990 ◽  
Vol 72 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Akira Ogawa ◽  
Michiyasu Suzuki ◽  
Yoshiharu Sakurai ◽  
Takashi Yoshimoto
Keyword(s):  
Anterior Cerebral Artery ◽  
Vascular Anomaly ◽  
Vascular Anomalies ◽  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Operative Field ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Median Artery ◽  
Vascular Structures

✓ Direct operations were performed on 206 patients with aneurysms of the anterior communicating artery (ACoA) using a bifrontal craniotomy and an interhemispheric approach. A total of 44 (21.4%) of these patients had vascular anomalies in the vicinity of the ACoA; these included a median artery of the corpus callosum (MACC) in 27 cases (13.1%), duplication of the ACoA in 20 (9.7%), and duplication of the A1 segment of the anterior cerebral artery in one (0.5%). A retrospective study of the angiograms indicated that diagnosis of the A1 or ACoA duplication was not possible; only 11 (41%) of the 27 MACC's were easily identified, while eight (30%) could not be diagnosed. The majority of the cases of ACoA aneurysms with MACC (81.5%) showed trifurcation of the ACoA, A2, and MACC. The operative results in the patients with MACC did not differ significantly from the results of the entire ACoA aneurysm series. From the above study it is concluded that, regardless of whether a vascular anomaly has been identified preoperatively, ACoA aneurysm surgery should be undertaken with that possibility in mind. A bifrontal craniotomy and an interhemispheric approach has the advantage of allowing for a wide operative field and the attainment of a good understanding of the vascular structures near the ACoA. It is particularly useful in cases of vascular anomaly in this region.

Venous infarction following the interhemispheric approach in patients with acute subarachnoid hemorrhage

1991 ◽  
Vol 74 (5) ◽  
pp. 715-729 ◽  
Author(s):  
Kazuo Tsutsumi ◽  
Yoshiaki Shiokawa ◽  
Tatsuo Sakai ◽  
Nobuhiko Aoki ◽  
Masaru Kubota ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Venous Drainage ◽  
Acute Stage ◽  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Venous Infarction ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Acute Subarachnoid Hemorrhage ◽  
Bridging Veins

✓ 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.

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

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-65-ons-74 ◽  
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.

Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery

1986 ◽  
Vol 64 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Jiro Suzuki ◽  
Kazuo Mizoi ◽  
Takashi Yoshimoto
Keyword(s):  
Cerebral Arteries ◽  
Distal Portion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Early Operations ◽  
Temporary Clip ◽  
Fine Print

✓ The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration. To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.

Low Anterior Interhemispheric Approach - A Narrow Corridor to Aneurysms of the Anterior Communicating Artery

2001 ◽  
Vol 143 (9) ◽  
pp. 885-891 ◽  
Author(s):  
H. El-Noamany ◽  
F. Nakagawa ◽  
K. Hongo ◽  
Y. Kakizawa ◽  
S. Kobayashi
Keyword(s):  
Anterior Communicating Artery ◽  
Interhemispheric Approach ◽  
Anterior Interhemispheric Approach

Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex

1976 ◽  
Vol 45 (3) ◽  
pp. 259-272 ◽  
Author(s):  
David Perlmutter ◽  
Albert L. Rhoton
Keyword(s):  
Optic Tract ◽  
Cerebral Aneurysms ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Proximal Half ◽  
Clinical Consequences ◽  
The Right ◽  
Perforating Arteries

✓ The microvascular relationships important to surgery of aneurysms in the anterior communicating region were defined in 50 cadaver brains. The recurrent artery of Heubner was frequently exposed before the A-1 segment in defining the neck on anterior cerebral aneurysms because it commonly courses anterior to A-1. It arose from the A-2 segment of the anterior cerebral artery (ACA) in 78% and most commonly terminated in the area of the anterior perforated substance, and lateral to it in the Sylvian fissure. The anterior communicating artery (ACoA) frequently gave rise to perforating arteries which terminated in the superior surface of the optic chiasm and above the chiasm in the anterior hypothalamus. This finding contrasts with previous reports that no perforating branches arise from the communicating artery. The proximal half of the A-1 segment was a richer source of perforating arteries than the distal half. The A-1 branches most commonly terminated in the anterior perforated substance, the optic chiasm, and the region of the optic tract. The ACoA increased in size as the difference in the diameter between the right and left A-1 segments increased. Frequent variants such as double or triple ACoA's, triple A-2 segments, and duplication of the A-1 segments were encountered. The clinical consequences of occlusion of the recurrent artery and of the perforators from the ACoA and medial and lateral segment of A-1 are reviewed.

scholarly journals Paramedian thalamic infarction caused by cisternal drain placement in open clipping for aneurysmal subarachnoid hemorrhage: Two case reports

2020 ◽  
Vol 11 ◽  
pp. 164
Author(s):  
Sho Tsunoda ◽  
Tomohiro Inoue ◽  
Hideaki Ono ◽  
Kazuaki Naemura ◽  
Atsuya Akabane
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Reports ◽  
Anatomical Variation ◽  
Anterior Communicating Artery ◽  
Prepontine Cistern ◽  
Interhemispheric Approach ◽  
Thalamic Infarction ◽  
Anterior Interhemispheric Approach ◽  
Drain Placement ◽  
Cisternal Drainage

Background: Some complications associated with cisternal drainage have been reported; however, there are few reports on direct vascular injury caused by cisternal drain. We experienced two rare cases of thalamic infarction caused by cisternal drain placement during open clipping for a ruptured anterior communicating artery (AcomA) aneurysm through an anterior interhemispheric approach. Case Description: Two cases of ruptured AcomA aneurysm were treated by surgical clipping through an anterior interhemispheric approach, and then a cisternal drain was inserted from opticocarotid space toward prepontine cistern. Postoperatively, the magnetic resonance imaging showed unilateral anterior-medial thalamic infarction in both two cases. By reviewing the postoperative computed tomography and digital subtraction angiography, it was suspected that the cisternal drain, which was inserted slightly deep, obstructed the P1 perforator because of an anatomical variation involving a lowered basilar bifurcation and caused postoperative unilateral paramedian thalamic infarction. Conclusion: To avoid these complications, neurosurgeons should consider the potential for P1 perforator injury related to cisternal drain placement.

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