Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to th
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TECHNICAL NOTE
Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to the operative room G. La Rocca 1,2 & G. Sabatino 1,2 & Roberto Altieri 3,4 A. Olivi 1 & G. M. Della Pepa 1
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& E. Mazzucchi & A. Rapisarda & T. Ius & D. Garbossa & F. Cofano &
Received: 19 May 2020 / Revised: 11 August 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The operative approach to the posterior incisural space is challenging because of its deep location, the surrounding eloquent areas, and the intimate relationship with the deep veins. Several approaches have been proposed to manage the lesions in this region: supratentorial, infratentorial and a combination of them. Brain retraction, injury to the occipital lobe and corpus callosum, and venous bleeding are the principle drawbacks of these routes. We performed anatomical dissection study using 10 embalmed human cadaver specimens injected with colored latex exploring a different route, parietal interhemispheric transfalcine transtentorial (PITT). Then we used a PITT approach on two patients with posterior incisural space (PIS) lesions. The PITT approach led to successful and safe complete removal of PIS lesions in our cases. No complications were reported. The present approach could be a valuable option in case of PIS lesions, especially those associated with downward displacement of the deep venous complex; thanks to the gravity it reduce the complications related to the occipital lobe retraction and manipulation. Moreover, cutting the superior-anterior edge of the tentorium, the sub-tentorial space could be reached. Keywords Parietal interhemispheric transfalcine transtentorial . Occipital transtentorial . Posterior transventricular . Infratentorial supracerebellar
Introduction The posterior incisural space is a complex region located between the midbrain and the free edge of the tentorium. It contains relevant neurovascular structures, such as the vein of Galen (GV), basal vein of Rosenthal (BVR), internal occipital vein (IOV), posterior cerebral arteries (PCA), splenium
* Roberto Altieri [email protected] 1
Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Division of Neurosurgery, Department of Neurosciences, Policlinico “G. Rodolico” University Hospital, Catania, Italy
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Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
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Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia, University Hospital, Udine, Italy
of corpus callosum, superior vermis, and trochlear nerve. It represents the junction of the supratentorial and infratentorial compartments [1]. Lesions in the posterior incisural space (PIS) may be approached through numerous supratentorial or infratentorial routes or a combination of both accordi
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