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…
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…
Magnetic Resonance Imaging Surveillance for Vestibular Schwannoma After Microsurgical Resection Using a Retrosigmoid Transmeatal Approach.
BACKGROUND Vestibular schwannoma (VS) is a benign, usually slow-growing tumor. The drawback of radical microsurgical VS resection is the increased likelihood of neurologic injury, forcing surgeons to leave a tumor remnant in some cases. We evaluated the prognostic value of magnetic resonance imaging (MRI) enhancement patterns to determine the risk of tumor regrowth. METHODS This clinical study included 30 patients (20 women and 10 men) with VS who underwent surgery via a retrosigmoid transmeatal approach. The extent of resection was assessed by MRI 6 months after surgery. Two subtypes of intracanalicular linear enhancement were defined: linear enhancement of the walls of the internal audito…