Interhemispheric transcallosal approach: going further based on the vascular anatomy

Area of Science:

• Neurosurgery
• Neuroanatomy
• Radiology

Background:

• Preserving cortical frontal bridging veins is crucial for good neurological outcomes in anterior interhemispheric transcallosal approaches.
• These approaches are typically used to access intraventricular tumors.
• Vein variability presents challenges in surgical planning.

Purpose of the Study:

• To statistically analyze cerebral angiographies to identify vein-free areas for craniotomy placement.
• To challenge the assumption of extreme variability in bridging vein anatomy.
• To optimize surgical corridors for anterior interhemispheric transcallosal approaches.

Main Methods:

• Statistical analysis of 100 selective cerebral angiographies.
• Determination of the most probable vein-free area for craniotomy.
• Measurement of distances to pre-coronal and post-coronal veins relative to the coronal suture.

Main Results:

• The optimal craniotomy centering point was found to be 2.86 cm anterior to the coronal suture.
• A purely pre-coronal 5 cm craniotomy demonstrated a 92.0% probability of being vein-free at 4 cm anterior to the coronal suture.
• Significantly fewer bridging veins (0.53) were found anterior to the coronal suture compared to posterior regions (8.47).

Conclusions:

• A purely pre-coronal 5 cm craniotomy is recommended for anterior interhemispheric approaches.
• This approach minimizes the risk of encountering cortical frontal bridging veins.
• Optimized craniotomy placement enhances surgical safety and neurological outcomes.