title: Microsurgical and Endoscopic Posterior Transcortical Keyhole Approach to the Atrium of the Lateral Ventricle: A Cadaveric Study.
abstract: OBJECTIVE
  Accessing large lesions located in the atrium of the lateral ventricle without causing a neurologic deficit can be challenging. The aim of this study was to evaluate a modification of the posterior transcortical approach that may create sufficient exposure to the atrium of the lateral ventricle with less injury to the brain cortex and fibers using a technique that combines a microscope with an endoscope.
  
  
  METHODS
  Craniotomy procedures performed using the posterior transcortical keyhole approach were simulated on 10 adult cadaveric heads (20 hemispheres). The anatomical structures in the lateral ventricle were observed through the microscope and endoscope. Three distance measurements on the intraparietal sulcus were recorded.
  
  
  RESULTS
  The anatomical structures related to the atrium of the lateral ventricle, including the calcar avis, corpus callosum bulb, caudate nucleus, pulvinar, and glomus, were clearly observed under the microscope. Via the endoscope, a wider visualization of anatomical structures could be obtained. The distance from the intersection of the intraparietal sulcus and postcentral sulcus to the cerebral longitudinal fissure was 35.36 ± 1.06 mm, the depth of the intraparietal sulcus was 19.16 ± 1.03 mm, and the distance from the bottom of the intraparietal sulcus to the lateral ventricle was 21.31 ± 1.32 mm.
  
  
  CONCLUSIONS
  The microsurgical posterior transcortical keyhole approach could provide an ideal exposure to the atrium and the posterior part of the body of the lateral ventricle. The endoscopic posterior transcortical keyhole approach demonstrated a wider viewing range compared with the microscope. An endoscopic-controlled or -assisted surgery may reduce damage to normal brain tissue, facilitate total resection of the lesion, and improve the surgical outcome.
authors.affiliation: Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Yizheng People's Hospital, Yizheng, Jiangsu, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Hengzhu
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Zhengcun
authors.initials: Z
authors.lastname: Yan
authors.affiliation: Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
authors.forename: Lei
authors.initials: L
authors.lastname: She
mesh_terms: D002102:Cadaver; D002548:Cerebral Revascularization / Q000379:methods*; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020547:Lateral Ventricles / Q000033:anatomy & histology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*