Interhemispheric transcallosal approach: going further based on the vascular anatomy

Abstract

Preserving cortical frontal bridging veins draining into the superior sagittal sinus is a factor of good neurological outcome in anterior interhemispheric transcallosal approaches, classically performed to reach intraventricular tumors. Challenging the idea that veins are utterly variable, we propose a statistical analysis of 100 selective cerebral angiographies to determine where to place the craniotomy in order to expose the most probable vein-free area. The mean distance to the first pre-coronal vein was 6.66 cm (± 1.73, 1.80 to 13.00) and to the first post-coronal vein 0.94 cm (± 0.92, 0 to 3.00) (p < 0.001). The probability of absence of bridging veins was 92.0% at 4 cm anterior to the coronal suture versus 37.5% at 1 cm and 12.5% at 2 cm posteriorly. The length of the surgical corridor (distance between the first pre-coronal and post-coronal vein) was 7.60 cm (± 1.72, 3.00 to 14.10). Overall, the ideal centering point of the craniotomy was 2.86 cm (± 1.08, − 0.65 to 6.50) ahead of the coronal suture. The mean number of veins within 6 cm behind the coronal suture was 8.47 (± 2.11, from 3 to 15) versus 0.530 (± 0.82, from 0 to 3) ahead of the coronal suture (p < 0.001). These findings support a purely pre-coronal 5 cm craniotomy for interhemispheric approaches.

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S.A. performed the analysis, drafted the manuscript, and approved the final version of the manuscript.

C.A. performed the analysis, drafted the manuscript, and approved the final version of the manuscript.

D.C. critically reviewed the manuscript and approved the final version of the manuscript.

C.L.G. critically reviewed the manuscript and approved the final version of the manuscript.

P.B. designed the study, performed the analysis, drafted the manuscript, and approved the final version of the manuscript.

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Correspondence to Caroline Apra.

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Aldea, S., Apra, C., Chauvet, D. et al. Interhemispheric transcallosal approach: going further based on the vascular anatomy. Neurosurg Rev (2021). https://doi.org/10.1007/s10143-021-01480-x

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Keywords

  • Angiography
  • DSA
  • Veins
  • Coronal suture
  • Callosotomy
  • Parasagittal vein