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Transanterior Limiting Sulcus of the Insula Approach: Novel Surgical Approach to the Ventral Striatum Region.
Párraga, Richard Gonzalo; Lahirish, Issa Ali Muftah; Ribas, Guilherme Carvalhal; Sarti, Talita Martins; da Costa, Marcos Devanir Silva; Chaddad-Neto, Feres.
Afiliação
  • Párraga RG; Director of the Neurosurgery Institute of Bolivia (INEB), Cochabamba, Bolivia.
  • Lahirish IAM; Department of Neurosurgery, Hospital Beneficência Portuguesa, São Paulo - SP, Brazil.
  • Ribas GC; Medical School, Hospital Israelita Albert Einstein, São Paulo - SP, Brazil.
  • Sarti TM; Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil.
  • da Costa MDS; Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil.
  • Chaddad-Neto F; Department of Neurosurgery, Hospital Beneficência Portuguesa, São Paulo - SP, Brazil; Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil. Electronic address: fereschaddad@hotmail.com.
World Neurosurg ; 169: e9-e15, 2023 01.
Article em En | MEDLINE | ID: mdl-36208868
BACKGROUND: Lesions in the ventral striatum region (above the anterior perforated substance) are a challenge for neurosurgeons due to their direct relationship with the lenticulostriate arteries, which difficult the surgical access. The standard approaches for this region include the following: 1) transfrontal approach, 2) transanterior perforating substance approach, 3) transcallosal transventricular approach, and 4) pterional transsylvian-transinsular route. In this study, we aimed to describe a novel anatomical approach through the anterior limiting sulcus of the insula in order to access the ventral striatum. METHODS: We reviewed the literature and performed a detailed dissection of this region by using Klingler's technique with brain specimens injected with silicone, paying special attention to the white fibers and lenticulostriate arteries, and provided a description of an illustrative case of a cavernous malformation. RESULTS: Neuroanatomical dissections showed that the lenticulostriate arteries had an inverted C-shaped anterior concavity, leaving less significant vascular relationships in the depth of the anterior limiting sulcus of the insula. In the case we described, the cavernous malformation was completely resected and the patient was discharged without any neurological deficits. CONCLUSIONS: The transanterior limiting sulcus of the insula approach to the ventral striatum offers a safe access route for selected cases and can be performed on the basis of anatomical references. Three-dimensional understanding of the intrinsic brain architecture and its relationships with vascular structures in this specific area is important and can be acquired mainly through laboratory training.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procedimentos Neurocirúrgicos / Córtex Insular Limite: Humans Idioma: En Revista: World Neurosurg Assunto da revista: NEUROCIRURGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Bolívia País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procedimentos Neurocirúrgicos / Córtex Insular Limite: Humans Idioma: En Revista: World Neurosurg Assunto da revista: NEUROCIRURGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Bolívia País de publicação: Estados Unidos