sulcus safe entry zone as previously described. 3 , 4 , 5 For lesions located in the ventromedial midbrain and medial to the oculomotor nerve, the interpeduncular safe entry zone can be used to remove lesions with acceptable patient morbidity. The key to using the interpeduncular fossa safe entry zone is to remain flexible and at times to resort to using a contralateral approach with a modified orbitozygomatic craniotomy to obtain the trajectory and view necessary to remove lesions from the ventromedial midbrain. As demonstrated by the quantitative anatomical
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M. Yashar S. Kalani, Kaan Yağmurlu, and Robert F. Spetzler
W. Bryan Wilent, Michael Y. Oh, Cathrin M. Buetefisch, Julian E. Bailes, Diane Cantella, Cindy Angle, and Donald M. Whiting
contact of the implanted DBS lead is in the ventromedial aspect of the lateral hypothalamus, 3.8 mm ventral to the midcommissural line (axial section), 4.7 mm from the midline (sagittal section) and 6.0 mm anterior to the midcommissural point (coronal section). This procedure was then repeated for the right side where the electrode was inserted at a lateral angle of 29.2° and an anterior angle of 44.3°. Compared with the location of the left side lead, the location of the bottom contact of the right side lead was slightly more lateral (8.2 mm) and anterior (8.0 mm) but
Robert K. Erickson, Frederick D. Brown, Keith L. Schaible, and Robert L. Wollmann
Hypothalamic grafts successfully grow and differentiate within the ventricular system. 12, 18, 29 The ventromedial hypothalamus (VMH) is the site of the classic lesion which produces an obese hyperphagic animal. 6 The exact anatomic and neurochemical events by which an animal becomes obese following induction of the lesion are at present undefined and controversial; effective lesions have been produced with electrocoagulation, radiofrequency, knife cuts, and toxins placed in a variety of locations. 14, 15, 17, 22, 26 In addition to rapid weight gain, the hyperphagic
Frederick D. Brown, Richard G. Fessler, Jacob R. Rachlin, and Sean Mullan
I n the early 1940's it was noted that lesions of specific brain areas led to alterations in normal food and water intake: a lesion of the ventromedial hypothalamus (VMH) led to overeating and obesity, 9, 10 whereas a lesion of the lateral hypothalamus (LH) led to anorexia. 3 Anand and Dua 4 then reported that electrical stimulation of the LH induced a pronounced bout of eating in previously satiated cats, and that electrical stimulation of the VMH caused food-deprived cats to stop eating. Since these original observations, a large body of literature has
Goran Laćan, Antonio A. F. De Salles, Alessandra A. Gorgulho, Scott E. Krahl, Leonardo Frighetto, Eric J. Behnke, and William P. Melega
have been extended to the treatment of epilepsy, obsessive–compulsive disorder, and refractory depression and to the control of orthostatic hypotension in patients with chronic neuropathic pain. 17 , 19 , 20 , 30 Recently, electrodes were implanted in the ventromedial posterior hypothalamus for long-term DBS treatment of intractable cluster headaches. 14 , 32 , 34 , 36 , 48 The therapeutic approach was based solely on the adoption of DBS methods used successfully in the treatment of PD, with the assumption that high-frequency DBS would exert similar inhibitory
Taylor J. Abel, Kenneth Manzel, Joel Bruss, Amy M. Belfi, Matthew A. Howard III, and Daniel Tranel
associated with anterior skull base meningiomas. Anterior skull base meningiomas often involve the ventromedial prefrontal cortex (vmPFC), which is implicated in various higher cognitive functions (including value-based decision-making 5 and moral judgments 17 ) and also in emotional regulation 1 and personality. 2 , 3 Interestingly, although anterior skull base meningiomas frequently involve (and lesion) the vmPFC, the cognitive and behavioral manifestations of anterior skull base meningiomas remain poorly understood. 26 Several authors have reported minimal change
Joshua D. Burks, Andrew K. Conner, Phillip A. Bonney, Chad A. Glenn, Cordell M. Baker, Lillian B. Boettcher, Robert G. Briggs, Daniel L. O’Donoghue, Dee H. Wu, and Michael E. Sughrue
S ince Brodmann first characterized the orbitofrontal cortical region in 1909, 28 our knowledge of the prefrontal cortex has expanded to include its role in executive behavior and cognition. As our understanding of the prefrontal cortex has increased, it has become more apparent that its dorsolateral, ventromedial, and orbitofrontal subdivisions serve specific functions. 3 For instance, it is clear that the orbitofrontal gyri are important in decision making. 30 Human neuroimaging and animal lesion studies have demonstrated that this area plays a critical
Arthur F. Battista, Menek Goldstein, Susumu Nakatani, and Berta Anagnoste
. Transformation of tyrosine to dopamine. In the Rhesus monkey, Ward, et al. , in 1948, 20 Peterson, et al. , 15 Carrea and Mettler, 6 Carpenter, 5 and Poirier 16 were able to induce a postural tremor in the contralateral extremities by a lesion in the ventromedial tegmental area. Such a tegmental lesion resulting in tremor of the contralateral extremities was found, by Poirier and Sourkes in 1965, 17 to be associated with an extremely low endogenous dopamine and a low norepinephrine content in the striatum ipsilateral to the lesion. These findings correlate well
Daniel A. N. Barbosa, Ricardo de Oliveira-Souza, Felipe Monte Santo, Ana Carolina de Oliveira Faria, Alessandra A. Gorgulho, and Antonio A. F. De Salles
nuclei; Pv = paraventricular nucleus; Sc = suprachiasmatic (ovoid) nucleus; So = supraoptic (tangential) nucleus; Tm = tuberomammillary (mammilloinfundibularis) nucleus; Vf = ventricular foramen; Vm = ventromedial (tuber principal) nucleus. For targeting and stereotactic orientation in relation to the intercommissural (anterior commissure–posterior commissure) line, see Lemaire et al. 50 Panels A and C are reproduced from Lemaire JJ, Nezzar H, Sakka L, Boirie Y, Fontaine D, Coste A, et al: Maps of the adult human hypothalamus. Surg Neurol Int 4: S156-163, 2013. CC BY
Shigeaki Kobayashi, Kazuhiko Kyoshima, Hirohiko Gibo, Sathyaranjandas A. Hegde, Toshiki Takemae, and Kenichiro Sugita
subgroup of carotid artery aneurysms that arise from the proximal and ventromedial portion of the intradural ICA, and grow in a small dural recess with their apex toward the cavernous sinus. These aneurysms may extend into the intracavernous space and always pose problems at surgery. This report presents our experience with this subgroup of “carotid cave” aneurysms, highlighting the relevant surgical anatomy and operative details for a successful surgical outcome. Summary of Cases Patient Population In the past 10 years, 32 cases of carotid-ophthalmic artery
