title: Microsurgical and endoscopic approaches to the pulvinar.
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.
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida.|Department of Neurosurgery, Juntendo University, Tokyo.
authors.forename: Osamu
authors.initials: O
authors.lastname: Akiyama
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida.|Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida.|Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery, and Psychiatry, Istanbul, Turkey.
authors.forename: Abuzer
authors.initials: A
authors.lastname: Gungor
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida.|Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Department of Anatomical Sciences, St. George's University, St. George's, Grenada.
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Goodrich
authors.affiliation: Department of Anatomical Sciences, St. George's University, St. George's, Grenada.|Seattle Science Foundation, Seattle, Washington.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Semmes-Murphey Neurologic & Spine Institute and Le Bonheur Children's Hospital, Memphis, Tennessee; and.
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
authors.affiliation: Department of Neurosurgery, Juntendo University, Tokyo.
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Rhoton
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000601:surgery*; D002102:Cadaver; D005260:Female; D006801:Humans; D008866:Microsurgery; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures / Q000379:methods*; D020649:Pulvinar / Q000601:surgery*
keywords: anatomy; arteriovenous malformation; brain tumor; endoscope; pulvinar; surgical approaches