Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar: Ipsilateral Versus Contralateral Corridors

Salomon Cohen-Cohen, Aaron Cohen-Gadol, Juan L. Gomez-Amador, Joao T. Alves-Belo, Kushal J. Shah, Juan C. Fernandez-Miranda

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Due to the critical neurovascular structures that surround the pulvinar, deciding the best surgical approach can be challenging, with multiple options available. OBJECTIVE: To analyze and compare the ipsilateral vs the contralateral version of the 2 main approaches to the cisternal pulvinar surface: paramedian supracerebellar infratentorial (PSCI) and interhemispheric occipital transtentorial (IOT). METHODS: The PSCI and IOT approaches were performed on 7 formalin-fixed adult cadaveric heads to evaluate qualitatively and quantitatively the microsurgical exposure of relevant anatomic structures. We quantitatively measured the corridor distance to our target with each approach. RESULTS: The ipsilateral PSCI approach provided an easier access and a better exposure of the anteromedial portion of the cisternal pulvinar surface. The contralateral approach provided a wider and more accessible exposure of the posterolateral portion of the cisternal pulvinar surface. When protrusion of the posterior parahippocampal gyrus above the free edge of the tentorium was present, the contralateral PSCI approach provided an unobstructed view to both areas. The IOT approach provided a better view of the anteromedial portion of the cisternal pulvinar surface, especially with a contralateral approach. CONCLUSION: Multiple approaches to the pulvinar have been described, modified, and improved. Based on this anatomic study we believe that although the corridor distance with a contralateral approach is longer, the surgical view and access can be better. We recommend the use of a PSCI contralateral approach especially when a significant protrusion of the posterior parahippocampal gyrus is present.

Original languageEnglish (US)
Pages (from-to)351-359
Number of pages9
JournalOperative neurosurgery (Hagerstown, Md.)
Volume16
Issue number3
DOIs
StatePublished - Mar 1 2019

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Pulvinar
Parahippocampal Gyrus
Formaldehyde
Head

Keywords

  • Cisternal
  • Contralateral
  • Ipsilateral
  • Occipital-transtentorial
  • Pulvinar
  • Supracerebellar

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar : Ipsilateral Versus Contralateral Corridors. / Cohen-Cohen, Salomon; Cohen-Gadol, Aaron; Gomez-Amador, Juan L.; Alves-Belo, Joao T.; Shah, Kushal J.; Fernandez-Miranda, Juan C.

In: Operative neurosurgery (Hagerstown, Md.), Vol. 16, No. 3, 01.03.2019, p. 351-359.

Research output: Contribution to journalArticle

Cohen-Cohen, Salomon ; Cohen-Gadol, Aaron ; Gomez-Amador, Juan L. ; Alves-Belo, Joao T. ; Shah, Kushal J. ; Fernandez-Miranda, Juan C. / Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar : Ipsilateral Versus Contralateral Corridors. In: Operative neurosurgery (Hagerstown, Md.). 2019 ; Vol. 16, No. 3. pp. 351-359.
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abstract = "BACKGROUND: Due to the critical neurovascular structures that surround the pulvinar, deciding the best surgical approach can be challenging, with multiple options available. OBJECTIVE: To analyze and compare the ipsilateral vs the contralateral version of the 2 main approaches to the cisternal pulvinar surface: paramedian supracerebellar infratentorial (PSCI) and interhemispheric occipital transtentorial (IOT). METHODS: The PSCI and IOT approaches were performed on 7 formalin-fixed adult cadaveric heads to evaluate qualitatively and quantitatively the microsurgical exposure of relevant anatomic structures. We quantitatively measured the corridor distance to our target with each approach. RESULTS: The ipsilateral PSCI approach provided an easier access and a better exposure of the anteromedial portion of the cisternal pulvinar surface. The contralateral approach provided a wider and more accessible exposure of the posterolateral portion of the cisternal pulvinar surface. When protrusion of the posterior parahippocampal gyrus above the free edge of the tentorium was present, the contralateral PSCI approach provided an unobstructed view to both areas. The IOT approach provided a better view of the anteromedial portion of the cisternal pulvinar surface, especially with a contralateral approach. CONCLUSION: Multiple approaches to the pulvinar have been described, modified, and improved. Based on this anatomic study we believe that although the corridor distance with a contralateral approach is longer, the surgical view and access can be better. We recommend the use of a PSCI contralateral approach especially when a significant protrusion of the posterior parahippocampal gyrus is present.",
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T1 - Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar

T2 - Ipsilateral Versus Contralateral Corridors

AU - Cohen-Cohen, Salomon

AU - Cohen-Gadol, Aaron

AU - Gomez-Amador, Juan L.

AU - Alves-Belo, Joao T.

AU - Shah, Kushal J.

AU - Fernandez-Miranda, Juan C.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND: Due to the critical neurovascular structures that surround the pulvinar, deciding the best surgical approach can be challenging, with multiple options available. OBJECTIVE: To analyze and compare the ipsilateral vs the contralateral version of the 2 main approaches to the cisternal pulvinar surface: paramedian supracerebellar infratentorial (PSCI) and interhemispheric occipital transtentorial (IOT). METHODS: The PSCI and IOT approaches were performed on 7 formalin-fixed adult cadaveric heads to evaluate qualitatively and quantitatively the microsurgical exposure of relevant anatomic structures. We quantitatively measured the corridor distance to our target with each approach. RESULTS: The ipsilateral PSCI approach provided an easier access and a better exposure of the anteromedial portion of the cisternal pulvinar surface. The contralateral approach provided a wider and more accessible exposure of the posterolateral portion of the cisternal pulvinar surface. When protrusion of the posterior parahippocampal gyrus above the free edge of the tentorium was present, the contralateral PSCI approach provided an unobstructed view to both areas. The IOT approach provided a better view of the anteromedial portion of the cisternal pulvinar surface, especially with a contralateral approach. CONCLUSION: Multiple approaches to the pulvinar have been described, modified, and improved. Based on this anatomic study we believe that although the corridor distance with a contralateral approach is longer, the surgical view and access can be better. We recommend the use of a PSCI contralateral approach especially when a significant protrusion of the posterior parahippocampal gyrus is present.

AB - BACKGROUND: Due to the critical neurovascular structures that surround the pulvinar, deciding the best surgical approach can be challenging, with multiple options available. OBJECTIVE: To analyze and compare the ipsilateral vs the contralateral version of the 2 main approaches to the cisternal pulvinar surface: paramedian supracerebellar infratentorial (PSCI) and interhemispheric occipital transtentorial (IOT). METHODS: The PSCI and IOT approaches were performed on 7 formalin-fixed adult cadaveric heads to evaluate qualitatively and quantitatively the microsurgical exposure of relevant anatomic structures. We quantitatively measured the corridor distance to our target with each approach. RESULTS: The ipsilateral PSCI approach provided an easier access and a better exposure of the anteromedial portion of the cisternal pulvinar surface. The contralateral approach provided a wider and more accessible exposure of the posterolateral portion of the cisternal pulvinar surface. When protrusion of the posterior parahippocampal gyrus above the free edge of the tentorium was present, the contralateral PSCI approach provided an unobstructed view to both areas. The IOT approach provided a better view of the anteromedial portion of the cisternal pulvinar surface, especially with a contralateral approach. CONCLUSION: Multiple approaches to the pulvinar have been described, modified, and improved. Based on this anatomic study we believe that although the corridor distance with a contralateral approach is longer, the surgical view and access can be better. We recommend the use of a PSCI contralateral approach especially when a significant protrusion of the posterior parahippocampal gyrus is present.

KW - Cisternal

KW - Contralateral

KW - Ipsilateral

KW - Occipital-transtentorial

KW - Pulvinar

KW - Supracerebellar

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DO - 10.1093/ons/opy173

M3 - Article

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JO - Operative Neurosurgery

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