Microsurgical and endoscopic approaches to the pulvinar

Osamu Akiyama, Ken Matsushima, Abuzer Gungor, Satoshi Matsuo, Dylan J. Goodrich, R. Shane Tubbs, Paul Klimo, Aaron Cohen-Gadol, Hajime Arai, Albert L. Rhoton

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: Approaches to the pulvinar remain challenging because of the depth of the target, surrounding critical neural structures, and complicated arterial and venous relationships. The purpose of this study was to compare the surgical approaches to different parts of the pulvinar and to examine the efficacy of the endoscope as an adjunct to the operating microscope in this area. METHODS: The pulvinar was examined in 6 formalin-fixed human cadaveric heads through 5 approaches: 4 above and 1 below the tentorium. Each approach was performed using both the surgical microscope and 0° or 45° rigid endoscopes. RESULTS: The pulvinar has a lateral ventricular and a medial cisternal surface that are separated by the fornix and the choroidal fissure, which wrap around the posterior surface of the pulvinar. The medial cisternal part of the pulvinar can be further divided into upper and lower parts. The superior parietal lobule approach is suitable for lesions in the upper ventricular and cisternal parts. Interhemispheric precuneus and posterior transcallosal approaches are suitable for lesions in the part of the pulvinar forming the anterior wall of the atrium and adjacent cisternal part. The posterior interhemispheric transtentorial approach is suitable for lesions in the lower cisternal part and the supracerebellar infratentorial approach is suitable for lesions in the inferior and medial cisternal parts. The microscope provided satisfactory views of the ventricular and cisternal surfaces of the pulvinar and adjacent neural and vascular structures. The endoscope provided multi-angled and wider views of the pulvinar and adjacent structures. CONCLUSIONS: A combination of endoscopic and microsurgical techniques allows optimal exposure of the pulvinar.

Original languageEnglish (US)
Pages (from-to)630-645
Number of pages16
JournalJournal of Neurosurgery
Volume127
Issue number3
DOIs
StatePublished - Sep 1 2017

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Pulvinar
Endoscopes
Parietal Lobe
Formaldehyde
Blood Vessels
Head

Keywords

  • Anatomy
  • Arteriovenous malformation
  • Brain tumor
  • Endoscope
  • Pulvinar
  • Surgical approaches

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Akiyama, O., Matsushima, K., Gungor, A., Matsuo, S., Goodrich, D. J., Tubbs, R. S., ... Rhoton, A. L. (2017). Microsurgical and endoscopic approaches to the pulvinar. Journal of Neurosurgery, 127(3), 630-645. https://doi.org/10.3171/2016.8.JNS16676

Microsurgical and endoscopic approaches to the pulvinar. / Akiyama, Osamu; Matsushima, Ken; Gungor, Abuzer; Matsuo, Satoshi; Goodrich, Dylan J.; Tubbs, R. Shane; Klimo, Paul; Cohen-Gadol, Aaron; Arai, Hajime; Rhoton, Albert L.

In: Journal of Neurosurgery, Vol. 127, No. 3, 01.09.2017, p. 630-645.

Research output: Contribution to journalArticle

Akiyama, O, Matsushima, K, Gungor, A, Matsuo, S, Goodrich, DJ, Tubbs, RS, Klimo, P, Cohen-Gadol, A, Arai, H & Rhoton, AL 2017, 'Microsurgical and endoscopic approaches to the pulvinar', Journal of Neurosurgery, vol. 127, no. 3, pp. 630-645. https://doi.org/10.3171/2016.8.JNS16676
Akiyama O, Matsushima K, Gungor A, Matsuo S, Goodrich DJ, Tubbs RS et al. Microsurgical and endoscopic approaches to the pulvinar. Journal of Neurosurgery. 2017 Sep 1;127(3):630-645. https://doi.org/10.3171/2016.8.JNS16676
Akiyama, Osamu ; Matsushima, Ken ; Gungor, Abuzer ; Matsuo, Satoshi ; Goodrich, Dylan J. ; Tubbs, R. Shane ; Klimo, Paul ; Cohen-Gadol, Aaron ; Arai, Hajime ; Rhoton, Albert L. / Microsurgical and endoscopic approaches to the pulvinar. In: Journal of Neurosurgery. 2017 ; Vol. 127, No. 3. pp. 630-645.
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