Anterior peri-insular quadrantotomy: a cadaveric white matter dissection study.

Details

Serval ID
serval:BIB_6EA94D34E525
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Anterior peri-insular quadrantotomy: a cadaveric white matter dissection study.
Journal
Journal of neurosurgery. Pediatrics
Author(s)
Gonzalez-Lopez P., Cossu G. (co-first), Pralong E., Baldoncini M., Messerer M., Daniel R.T.
ISSN
1933-0715 (Electronic)
ISSN-L
1933-0707
Publication state
In Press
Peer-reviewed
Oui
Pages
1-9
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Anterior quadrant disconnection represents a safe surgical option in well-selected pediatric patients with a large frontal lobe lesion anterior to the motor cortex. The understanding of the anatomy of the white matter tracts connecting the frontal lobe with the rest of the cerebrum forms the basis of a safe and successful disconnective surgery. The authors explored and illustrated the relevant white matter tracts sectioned during each surgical step using fiber dissection techniques.
Five human cadaveric hemispheres were dissected to illustrate the frontal connections in the 3 planes. The dissections were performed from lateral to medial, medial to lateral, and ventral to dorsal to describe the various tracts sectioned during the 4 steps of this surgery, namely the anterior suprainsular window, intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection.
At the beginning of each surgical step, the U fibers were cut. During the anterior suprainsular window, the superior longitudinal fasciculus (SLF), the uncinate fasciculus, and the inferior fronto-occipital fasciculus (IFOF) were visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. During the intrafrontal disconnection, the SLF was cut, along with the corona radiata. At the medial surface the cingulum was sectioned. The anterior callosotomy disconnected the anterior third of the body of the callosum, the genu, and the rostrum. The frontobasal disconnection addressed the last remaining fibers connecting the frontal lobe with the rest of the hemisphere, namely the anterior limb of the anterior commissure.
The anterior peri-insular quadrantotomy aims at effectively treating children with large lesions of the frontal lobe anterior to the motor cortex. A precise understanding of the gyral anatomy of this lobe along with the several white matter connections is crucial to avoid motor complications and to ensure complete disconnection.
Keywords
IFOF = inferior fronto-occipital fasciculus, SLF = superior longitudinal fasciculus, anterior quadrantotomy, disconnective surgery, epilepsy surgery, frontal lobe
Pubmed
Create date
03/01/2020 17:10
Last modification date
09/04/2020 6:21
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