Microsurgical Anatomy of the Insular Region and Operculoinsular Association Fibers and its Neurosurgical Application
Objective To analyze the three-dimensional relationships of the operculoinsular compartments, using standard hemispheric and white matter fiber dissection and review the anatomy of association fibers related to the operculoinsular compartments of the Sylvian fissure and the main white matter tracts located deep into the insula. The secondary aim of this study was to improve the knowledge on this complex region to safely address tumor, vascular, and epilepsy lesions with an integrated perspective of the topographic and white matter fiber anatomy using 2D and 3D photographs. Methods Six cadaveric hemispheres were dissected. Two were fixed with formalin and the arteries were injected with red …
Gyral and Sulcal Microsurgical Anatomy
Abstract The complex set of sulci and gyri on the surface of the brain form a map with which neurosurgeons should be familiar when it comes to planning and carrying out their procedures, more particularly in the case of intrinsic brain lesions. Based on the general organization of the lobes and gyral convolutions of the brain, as defined by sulci and fissures, the pre- and intraoperative identification of the anatomical features of each patient is of critical importance. Knowledge of brain morphology is also essential to identify its different functional areas, given that both are closely associated. The correct interpretation of the excellent imaging techniques that are currently available…
The Smith-Robinson Approach to the Subaxial Cervical Spine: A Stepwise Microsurgical Technique Using Volumetric Models From Anatomic Dissections.
BACKGROUND: The Smith-Robinson1 approach (SRA) is the most widely used route to access the anterior cervical spine. Although several authors have described this approach, there is a lack of the stepwise anatomic description of this operative technique. With the advent of new technologies in neuroanatomy education, such as volumetric models (VMs), the understanding of the spatial relation of the different neurovascular structures can be simplified. OBJECTIVE: To describe the anatomy of the SRA through the creation of VMs of anatomic dissections. METHODS: A total of 4 postmortem heads and a cervical replica were used to perform and record the SRA approach to the C4-C5 level. The most relevant…
Novel Simulation Model with Pulsatile Flow System for Microvascular Training, Research, and Improving Patient Surgical Outcomes
Background Simulation allows surgical trainees to acquire surgical skills in a safe environment. With the aim of reducing the use of animal experimentation, different alternative nonliving models have been pursued. However, one of the main disadvantages of these nonliving models has been the absence of arterial flow, pulsation, and the ability to integrate both during a procedure on a blood vessel. In the present report, we have introduced a microvascular surgery simulation training model that uses a fiscally responsible and replicable pulsatile flow system. Methods We connected 30 human placentas to a pulsatile flow system and used them to simulate aneurysm clipping and vascular anastomosi…
White Matter Relationships Examined by Transillumination Technique Using a Lateral Transcortical Parietal Approach to the Atrium: Three-Dimensional Images and Surgical Considerations
Background Numerous lesions are found in the ventricular atrium (VA). Access is gained through many white matter tracts with great relevance and specific neurologic functions. It is important to understand the configuration of the most relevant structures surrounding this zone and, thus, select the safest entry zone on the lateral cerebral surface. Objective We studied the white matter layers traversed in the lateral transcortical parietal approach through the intraparietal sulcus (IPS), adding a transillumination technique. With this knowledge, we selected the safest highway to improve this particular approach. Methods An in-depth study of the white matter tracts was performed on 24 cerebr…