title: The transsylvian trans-limen insular approach to the crural, ambient and interpeduncular cisterns.
abstract: BACKGROUND
  The authors introduce the transsylvian trans-limen insular approach to the crural, ambient and interpeduncular cisterns.
  
  
  METHODS
  The transsylvian trans-limen insular approach was performed in 7 patients; 3 for aneurysm, 2 for isolated temporal horn hydrocephalus, one for tumour and one for an arteriovenous malformation. This approach is summarized in 4 procedures; the exposure of the inferior limiting sulcus of the insular cortex, the exposure of the inferior horn of the lateral ventricle, the dissection of the inferior part of the choroidal fissure and the splitting of the inferior border of the limen insula.
  
  
  RESULTS
  Four among 7 patients underwent surgery for the lesions in the crural or ambient cistern. The other 3 patients underwent surgery for the lesion in the interpeduncular cistern. Two patients of the latter group postoperatively had temporal lobe infarction.
  
  
  CONCLUSIONS
  The transsylvian trans-limen insular approach may be indicated for lesions in the crural and the anterior ambient cisterns, and the lesions which need wider exposure of the interpeduncular cistern. For the former lesions, this approach can afford good results. For the latter lesions, careful brain retraction and some other techniques to avoid temporal lobe infarction are necessary. Further neuropsychological assessment should be also necessary to prove the validity of this approach.
authors.affiliation: Department of Neurosurgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. snagata@ns.med.kyushu-u.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Nagata
authors.forename: T
authors.initials: T
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000601:surgery*; D002535:Cerebral Aqueduct / Q000601:surgery*; D002540:Cerebral Cortex / Q000601:surgery*; D002946:Cisterna Magna / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome