Anatomic, qualitative, and quantitative evaluation of the variants of the infratentorial supracerebellar approach to the
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ORIGINAL ARTICLE
Anatomic, qualitative, and quantitative evaluation of the variants of the infratentorial supracerebellar approach to the posteroinferior thalamus Helbert de Oliveira Manduca Palmiero 1 & Davi Jorge Fontoura Solla 1 & Leonardo Borges dos Santos 1 & Manoel Jacobsen Teixeira 1 & Eberval Gadelha Figueiredo 1 Received: 1 August 2020 / Revised: 3 September 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The posteroinferior region of the thalamus is formed by the pulvinar, and it is surgically accessed through the infratentorial supracerebellar approach, between the midline and the retromastoid region. This study aimed to compare the paramedian, lateral, extreme lateral, and contralateral paramedian corridors with the posteroinferior thalamus through a suboccipital craniotomy and an infratentorial supracerebellar access. Ten cadavers were studied, and the microsurgical dissections were accompanied by the measurement of the variables using a neuronavigation system. Statistical analysis was performed using analysis of variance (ANOVA). The distance between the access midpoint at the cranial surface and pulvinar varied between 53.3 and 53.9 mm, the contralateral access being an exception (59.9 mm). The vertical angle ranged from 20.6° in the contralateral access to 23.5° in the lateral access. There was a gradual increase in the horizontal angle between the paramedian (17.4°), lateral (31.3°), and extreme lateral (43.7°) accesses. But, this angle in the contralateral access was 14.6°, similar to that of the paramedian access. The exposed area of the thalamus was 125.1 mm2 in the paramedian access, 141.8 mm2 in the lateral access, and 165.9 mm2 in the extreme lateral access, which was similar to that of the contralateral access (164.9 mm2). The horizontal view angle increased with lateralization of the access, which facilitated microscopic visualization. With regard to the exposure of the microsurgical anatomy, the extreme lateral and contralateral accesses circumvent the neural and vascular obstacles at the midline, allowing a larger area of anatomical exposure. Keywords Neuroanatomy . Microsurgery . Suboccipital craniotomy . Infratentorial Supracerebellar access . Thalamus . Pulvinar . Pineal
Introduction Generally, craniotomy provides a straight access from the cranial surface to the surgical target forming the surgical corridor [12]. The surgical target should be accessed through natural planes without causing damage to healthy tissue. Suboccipital craniotomy allows access to the infratentorial supracerebellar space, a corridor of access to the pineal region where the pulvinar is located, corresponding to the posteroinferior
* Helbert de Oliveira Manduca Palmiero [email protected] 1
Division of Neurosurgery, University of São Paulo Medical School, Dr. Enéas de Carvalho Aguiar Ave., R. 5083, Number 255, São Paulo 05403-000, Brazil
thalamus. The pulvinar can be accessed through the infratentorial supracerebellar route between the midl
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