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Surgical anatomy and functional connectivity of the limbic system

Karl-Olof Lövblad and Karl Schaller

callosi into the subcallosal region. The fimbriae of the hippocampus, as they move posteriorly along the choroidal fissure, become the crura of the fornix. The crura constitute the anterior and medial aspect of the anterior wall of the ventricular atrium, 24 and move upward and join in the midline inferior to the splenium of the corpus callosum , and then run anteriorly and inferiorly to the mammillary bodies. The Parahippocampus This structure starts with the uncus , of which it represents the major portion , and thus represents the inferomedial surface of

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Letter to the Editor. Endoscope-assisted hemispherotomy

P. Sarat Chandra and Manjari Tripathi

temporal horn only posteriorly. This is the most challenging component of the surgery and has to be worked both anterior to posterior and vice versa. Thus, this step is not just about temporal horn access. 4) Posterior disconnection. This point again was not clearly made by the authors. This is a line that joins the splenium to the choroid plexus and is a short but important disconnection. This effectively disconnects the temporal efferents, including the fornix and the tail of the caudate nucleus. These structures curve over the roof of the temporal horn along the

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Endoscope-assisted infratentorial–supracerebellar approach to the third ventricle: an anatomical study

Andrea Cardia, Manuela Caroli, Mauro Pluderi, Cesare Arienta, Sergio M. Gaini, Giuseppe Lanzino, and Manfred Tschabitscher

ventricle, the endoscope is advanced over the interthalamic adhesion. Two structures are then visible in the anterior wall of the ventricle: the column of fornix, connected medially by the anterior commissure; and the triangular recess, a triangular-shaped space that is delimited laterally by the two columns of fornix and by the anterior commissure at its base. In the inferior portion of the anterior wall of the third ventricle, the protuberance formed by the optic chiasm and upper optic recess can be seen ( Fig. 9 ). Between the anterior commissure superiorly and the

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Optimal entry point and trajectory for endoscopic third ventriculostomy: evaluation of 53 patients with volumetric imaging guidance

Clinical article

Fangxiang Chen and Peter Nakaji

O ver the past 2 decades, the popularity of ETV for the treatment of hydrocephalus has increased. It is now the approach of choice for treating certain forms of obstructive hydrocephalus. With technological advances in endoscopy and the accumulation of practical experience, a high success rate has been reported. 13 , 15 , 18–21 Although the complication rate associated with ETV is still relatively high, most complications are minor and transient. 2 , 5 , 10 , 18 One particularly pernicious complication is damage to the fornix during the approach to the

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Editorial

Diffusion tensor tractography and epilepsy

Fredric B. Meyer

fasciculus, and the anterior commissure. The discussion provides a scholarly perspective to the significance of these white matter tract visualizations. The authors also chose to consider what disconnection might occur when performing a selective amygdalohippocampectomy (selAH) through the middle temporal gyrus as pioneered by the senior author, Dr. Olivier. Predictably, their virtual resection disrupted the anterior one-third to one-half of the fornix, fibers connecting the 2 hippocampi, and fibers joining the orbitofrontal cortex. Somewhat surprising is that even with

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Hemorrhagic Colloid Cyst

his brain (1200 g) was found to have a bulging third ventricle floor; a 2-cm hemorrhagic cyst in this ventricle was adherent to the right thalamus and posterior surface of the pillars of the fornix. The connective tissue wall of the cyst had inner cuboidal epithelium. The outer surface of the cyst wall was attached by the choroid plexus. There were some elastic fibers in the cyst wall. The cyst contents consisted of hemorrhagic amorphous material, abundant clefts of cholesterol crystals bordered by foreign body giant cells, disintegrated neutrophils, and

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Suprachiasmatic translamina terminalis corridor used in endoscopic endonasal approach for resecting third ventricular craniopharyngioma

Ye Gu, Xiaobiao Zhang, Fan Hu, Yong Yu, Tao Xie, Chongjing Sun, and Wensheng Li

solid 3.6 × 3.0 × 2.8–cm TVC extending to the interpeduncular cistern inferiorly and compressing the fornix and bilateral foramen of Monro superiorly and the LT anteriorly. Obstructive hydrocephalus was also found. Tumor removal began with the ITMS corridor, but there was still a hidden tumor beyond the surgical field. The STLT corridor was used to remove the residual tumor with a straight view so that GTR was achieved ( Video 1 ). VIDEO 1. Intraoperative video of the patient in Case 1. Copyright Ye Gu. Published with permission. Click here to view with Media

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Augmented reality–assisted roadmaps during periventricular brain surgery

Florian Bernard, Julien Haemmerli, Gregory Zegarek, Daniel Kiss-Bodolay, Karl Schaller, and Philippe Bijlenga

presented in Table 1 . 17–21 TABLE 1. Major surgical periventricular landmarks and their functional role Approach Tracked Anatomical Structure Functional Role Disconnection Syndrome/Lesion Syndrome AR Role Lt Rt Frontal Caudate nucleus 21 Bottom up attention (goal directed), memory, learning, sleep, emotion, language 21 Bottom up attention (goal directed), memory, learning, sleep, emotion, language 21 Target structure Fornix 19 Memory Anterograde amnesia 19 Target structure IFG (pars

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Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Clinical article

Venelin Gerganov, Hussam Metwali, Amir Samii, Rudolf Fahlbusch, and Madjid Samii

without contrast enhancement. Tumor extension is presented in Table 2 . In the recent cases, diffusion tensor imaging–based reconstruction of the fornix was conducted before and after tumor removal. TABLE 2: Tumor extension in the suprasellar area based on preoperative radiological and intraoperative observations Case No. Compartment Suprasellar Retrosellar Retroclival Intraventricular Parasellar Temporal Antechiasmatic Others 1 yes yes yes yes no no yes CPA, prelamina terminalis 2 yes

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A Study of Gnosis, Praxis and Language Following Section of the Corpus Callosum and Anterior Commissure

Lt. Comdr. Andrew J. Akelaitis

. Operation . On March 19, 1941 a right fronto-parietal craniotomy was performed and the genu and anterior half of the body of the corpus callosum, the anterior commissure and the right limb of the fornix were sectioned. The septum pellucidum was incised. A bilateral leucotomy was then performed. The atrophy limited to the frontal poles suggested Pick's disease. Course . The operation was performed under local anesthesia and the patient was studied immediately after closure of the wound. She was a bit drowsy but in good spirits and cooperative. She tired very easily. As