Usefulness of 3D MR reconstruction in determining a smart craniotomy location in posterior interhemispheric approach

Abstract

INTRODUCTION: With posterior interhemispheric approach (PIA) it is possible to reach the cingulate gyrus, parahippocampal gyrus, splenium of the corpus callosum, thalamus and some other parasplenial neural and vascular structures. To expose this surgical corridor wide enough it is crucial to make a smart bone opening. In this study, usefulness of 3D reconstructions of the preoperative magnetic resonance images (MRI) prepared with a novel technique to reveal parietal bridging-vein and its anatomical relation with lambda is evaluated. METHODS: Between December 2011 and May 2013, for all virgin cases that were planned to be operated via PIA, 3D reconstructions of the preoperative MRI were prepared and compared with the surgical view. These 3D images were used to plan the craniotomy site. All cases were evaluated in means of adequate craniotomy size and complication of bridging vein injury. RESULTS: In the given period 24 virgin cases which were operated via PIA were included in the study. In all cases, the 3D-images were reflective of the surgical view after durotomy. Anatomical relations between lambda, parietooccipital notch and parietal bridging veins were shown and used for preoperative planning for craniotomy-site. Only in one case there were the need to extend the craniotomy caudally. There were no bridging vein injury. DISCUSSION AND CONCLUSION: The novel technique described in this study is useful for preoperative planning of craniotomy site in cases to be operated via PIA. This technique also facilitates the protection of bridging veins during craniotomy and durotomy by revealing its location prior to opening.

Keywords

• cerebral bridging veins
• lambda
• parieto-occipital notch
• posterior interhemispheric approach
• thalamic surgery