Türk Nöroşirürji Dergisi 2020 , Vol 30 , Num 1
Microsurgical Anatomy of White Matter Tracts in Hemispherotomy
1İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, İstanbul, Türkiye Hemispherotomy is a surgical procedure performed for refractory epilepsy due to wide hemispheric damage. This study focuses on the microanatomy of the white matter tracts transected in hemispherotomy and the relationship of the surgical landmarks used during intraventricular callosotomy. Incision of the temporal stem along the inferior limiting sulcus crosses the insulo-opercular fibers, uncinate, inferior occipitofrontal and middle longitudinal fasciculi, anterior commissure, and the optic and auditory radiations. The incision along the superior limiting sulcus transects insulo-opercular fibers and the genu and posterior limb of the internal capsule. The incision along the anterior limiting sulcus crosses the insulo-opercular fibers, anterior limb of the internal capsule, anterior commissure, and the anterior thalamic bundle. The disconnection of the posterior part of the corpus callosum may be incomplete, as it was in 85% of the hemispheres in this study, if the point at which the last cortical branch of the anterior cerebral artery (ACA) turns upward and disappears from view through the intraventricular exposure is used as the landmark for estimating the posterior extent of the callosotomy. The falx, followed to the posterior edge of the splenium, is a more reliable landmark for completing the posterior part of an intraventricular callosotomy. Anahtar Kelimeler : Callosotomy, Epilepsy, Fiber dissection, Hemispherotomy, Microsurgical anatomy, White matter tracts