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Alfredo Pedroza, Manuel Dujovny, James I. Ausman, Fernando G. Diaz, Jose Cabezudo Artero, S. Kim Berman, Haresh G. Mirchandani, and Felix Umansky

K nowledge of the microanatomical features of the interpeduncular fossa (IF) is of paramount importance for surgeons approaching vascular lesions of this area, particularly basilar bifurcation aneurysms. A number of studies of the vascular structures of the IF have used formalin-fixed specimens or injection-perfusion techniques. 1, 2, 6, 7, 10, 16, 18, 19, 21, 22, 28, 29, 31, 33, 36, 38, 40 We have investigated the microvascular anatomy of this region using unfixed human cadaver brains injected with polyester resin medium, and have found that this technique

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M. Yashar S. Kalani, Kaan Yağmurlu, and Robert F. Spetzler

This safe entry zone makes use of the placement of the pyramidal tract, which is located in the middle three-fifths of the cerebral peduncle , to remove ventral lesions by entering the brainstem medial to this tract, lateral to the oculomotor nerve (cranial nerve [CN] III), and between the posterior cerebral artery and the superior cerebellar artery . However, no safe entry zone has been described to reach deep lesions located ventral and medial to the oculomotor nerve in the midbrain. In this study, we describe the interpeduncular fossa as a novel, safe entry

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Kenichi Oyama, Ph.D., Daniel M. Prevedello, Leo F. S. Ditzel Filho, Jun Muto, Ph.D., Ramazan Gun, Edward E. Kerr, Bradley A. Otto, and Ricardo L. Carrau

neurovascular structures on the contralateral side in the interpeduncular cistern are technical limitations of the transpetrosal approach. Some of their patients underwent a second operation via the transsphenoidal approach because the surgeons had trouble accessing a part of sella turcica and/or superior-posterior part of the third ventricle. As the endoscopic endonasal approach provides direct access to the retroinfundibular area with complete interpeduncular cistern exposure, we favor the use of endoscopic endonasal approaches for most interpeduncular fossa tumors. We

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Joao Paulo Almeida, Dennis Tang, Varun R. Kshettry, Raj Sindwani, and Pablo F. Recinos

the left side and also had an extension into the interpeduncular fossa and prepontine cistern. Likely due to the previous rupture of the cyst, a superior portion of it, in close relationship with the right optic tract, had a different radiological characteristic and suggested a more fibrotic component of the tumor. In the CISS sequence, this fibrous part of the tumor is observed as a hypointense segment located in the right aspect of the suprasellar space. 1:45 Considering the progressive enlargement of the tumor in recent years as well as patient’s preference, it

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Kazuhiko Fujitsu and Takeo Kuwabara

embedded high in the interpeduncular fossa. We have developed a new surgical approach which involves detachment of the zygomatic arch and removal of the ridge of the lateral orbital rim (the posterior ridge of the frontal process of the zygomatic bone). This “zygomatic approach” provides a wide exposure of the anterior temporal lobe base, and allows an obliquely upward access to the interpeduncular cistern. The zygomatic approach uses the lowest possible supratentorial route, which permits excellent exposure of the lesions in the interpeduncular cistern. Operative

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Serdar Ercan, Alba Scerrati, Phengfei Wu, Jun Zhang, and Mario Ammirati

V isualization of the central skull base is challenging. The subtemporal approach is one of the routes used to expose the interpeduncular fossa and the basal diencephalon. A certain degree of temporal lobe retraction is needed to gain sufficient surgical exposure. 2 , 3 , 11 , 30 Keyhole subtemporal approaches and a zygomatic arch osteotomy have been proposed in an effort to decrease the amount of temporal lobe retraction. 3 , 4 , 6 , 7 , 10 , 13 , 15 , 16 , 18 , 24 However, the effects of these modified subtemporal approaches on temporal lobe retraction have

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Gabriel Zada, J. Diaz Day, and Steven L. Giannotta

, several CNs and the ICA may require untethering from their dural sleeves for better mobilization, so that sufficient retraction and exposure of structures such as the cavernous sinus and interpeduncular fossa is achieved. We retrospectively reviewed our combined experience in the surgical treatment of 66 patients who underwent a temporopolar approach to tumors of the central skull base and aneurysms of the upper basilar region. In this report, we review this series of patients and describe the operative technique used in these cases. Methods The medical records

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David E. Adler and Thomas H. Milhorat

above the level of the optic chiasm, through the third ventricle to the apex of the tentorial notch. The cerebral hemispheres were removed, leaving intact a small portion of diencephalon, the posterior portion of the falx, and the tentorium. A second saw cut was made to remove the entire squama of the temporal bone down to the floor of the cranial fossa. The optic nerves were cut rostral to the sella turcica. The optic chiasm was lifted and the mesencephalon was cut at the level of the interpeduncular fossa in the axial plane, extending posteriorly. The brainstem cut

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aspect of the dorsum sellae; 2) maximum notch width (MNW), the maximum width of the notch in the axial plane; 3) notch length (NL), the length of the tentorial notch from the superoposterior edge of the dorsum sellae to the apex of the notch; 4) posterior tentorial length, the shortest distance between the apex of the notch and the most anterior part of the confluence of the sinuses; 5) interpedunculoclival (IC) distance, the distance from the interpeduncular fossa to the superoposterior edge of the dorsum sellae; 6) apicotectal (AT) distance, the distance from the

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Michael L. Levy, Larry T. Khoo, J. Diaz Day, Mark Liker, and J. Gordon McComb

Complete extirpation of tumor remains the primary goal of neurosurgeons in treating intracranial craniopharyngiomas. The intimate relationship of these lesions with the structures of the skull base and the difficulties of obtaining adequate operative visualization often make total removal an elusive goal. The authors describe the use of a combined fronto-orbitozygomatic temporopolar craniotomy to maximize the operative corridor and thereby increase the probability of maximum tumor resection without morbidity and mortality. They applied this approach in four children with craniopharyngiomas that involved the sellar and parasellar, third ventricle, cavernous sinus, and interpeduncular fossa regions. The surgical results are summarized with a presentation of pre- and postoperative imaging from two illustrative cases. A detailed description of the operative procedure is provided with a comparison to other previously described surgical approaches.