The Anterior Subcallosal Approach to Third Ventricular and Suprasellar Lesions: Anatomical Description and Technical Note.

The Anterior Subcallosal Approach to Third Ventricular and Suprasellar Lesions: Anatomical Description and Technical Note.

World Neurosurg. 2015 Dec 22;

Authors: Liebelt BD, Hooten KG, Britz GW

Abstract
BACKGROUND: Surgical access to the third ventricle is challenging given the depth of the operative field and close proximity of vital neural structures that must be traversed. For anterior third ventricular lesions approach options include anterior transcallosal or transcortical, subfrontal, frontotemporal, or endonasal. The subcallosal approach, a trans-lamina terminalis approach, is unique in that the surgical corridor is just below the corpus callosum, minimizes retraction, and preserves corpus callosum integrity. Case examples are provided and an anatomical study delineating the dimensions of the surgical corridor is performed.
METHODS: Two latex injected cadaver heads were utilized to describe the subcallosal corridor. An MRI was obtained and registered with neuronavigation for correlative anatomical illustration. Depth, dimensions, and cross-sectional area were measured for the subcommunicating and supracommunicating corridors.
RESULTS: The surgical depth for anterior transcallosal, subcallosal, and subfrontal approaches was 7.5 cm, 7.7 cm, and 7.6 cm respectively. The average corridor dimensions for the subcallosal approach was 14.75 x 6.63 mm compared to 8.88 x 5.38 mm for the subcommunicating corridor. Cross sectional area of the subcommunicating corridor was 30.62 mm(2) compared to 80.42 mm(2) for supracommunicating. This was easily enlarged to 156.62 mm(2) with gentle retraction.
CONCLUSIONS: The anterior subcallosal approach is a safe approach for lesions of the third ventricle that avoids splitting the corpus callosum, resecting unnecessary brain, and minimizes brain retraction. This corridor is superior to the traditional subfrontal approach in terms of working space and compares favorably to the anterior transcallosal approach without disrupting the corpus callosum.

PMID: 26721617 [PubMed - as supplied by publisher]

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