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    Microsurgical and Tractographic Anatomical Study of Transtemporal-Transchoroidal Fissure Approaches to the Ambient Cistern
    (2021) Egemen, Emrah; Celtikci, Pinar; Dogruel, Yucel; Yakar, Fatih; Sahinoglu, Defne; Farouk, Mohamed; Adiguzel, Esat; Ugur, Hasan Caglar; Coskun, Erdal; Gungor, Abuzer; Microsurgical and Tractographic Anatomical Study of Transtemporal-Transchoroidal Fissure Approaches to the Ambient Cistern; 33313862
    BACKGROUND: Approaching ambient cistern lesions is still a challenge because of deep location and related white matter tracts (WMTs) and neural structures. OBJECTIVE: To investigate the white matter anatomy in the course of 3 types of transtemporal-transchoroidal fissure approaches (TTcFA) to ambient cistern by using fiber dissection technique with translumination and magnetic resonance imaging fiber tractography. METHODS: Eight formalin-fixed cerebral hemispheres were dissected on surgical corridor from the temporal cortex to the ambient cistern by using Klingler's method. The trans-middle temporal gyrus, trans-inferior temporal sulcus ( TITS), and trans-inferior temporal gyrus (TITG) approaches were evaluated. WMTs that were identified during dissection were then reconstructed on the Human Connectome Project 1021 individual template for validation. RESULTS: The trans-middle gyrus approach interrupted the U fibers, arcuate fasciculus (AF), the ventral segment of inferior frontoocipital fasciculus (IFOF), the temporal extensions of the anterior commissure (AC) posterior crura, the tapetum (Tp) fibers, and the anterior loop of the optic radiation (OR). The TITS approach interrupted U fibers, inferior longitudinal fasciculus (ILF), IFOF, and OR. The TITG approach interrupted the U fibers, ILF, andOR. The middle longitudinal fasciculus, ILF, and uncinate fasciculus (UF) were not interrupted in the trans-middle gyrus approach and the AF, UF, AC, and Tp fiberswere not interrupted in the TITS/gyrus approaches. CONCLUSION: Surgical planning of the ambient cistern lesions requires detailed knowledge aboutWMTs. Fiber dissection and tractography techniques improve the orientation during surgery and may help decrease surgical complications.
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    Microsurgical and White Matter Anatomy of the Hypothalamus: A Fiber Dissection Study Correlating With Magnetic Resonance Tractography
    (2021) Celtikci, Pinar; 35006657
    BACKGROUND: The hypothalamus has been shown to be a hub for the control of autonomic and endocrine functions as well as the emotional and behavioral state due to having white matter connections to both brainstem and the cerebrum. However, the white matter connectivity of the hypothalamus is not completely unraveled and there is no consensus in the literature regarding anatomical parcellation and target selection for deep brain stimulation (DBS) surgery. OBJECTIVE: To define and showcase the microsurgical and the white matter anatomy of the hypothalamic region by utilizing fiber dissection technique and fiber tractography. METHODS: A total of 24 formalin-fixed human brain hemispheres were dissected according to Klingler's fiber dissection method with the aid of a surgical microscope. Following morphometric measurements, the hypothalamus was segmented into 6 parts as anteromedial, anterolateral, posteromedial, posterolateral, superior, and inferior according to landmarks of anterior commissure- posterior commissure line and mamillary body. RESULTS: The diagonal band of Broca, the ventral amygdalohypothalamic fiber, stria terminalis, and fornix were related with the anteromedial part; cingulate bundle, supraoptic commissure, and frontopontine tracts were related with the anterolateral part; medial longitudinal fasciculus, dorsal longitudinal fasciculus were related with the posteromedial part; and fasciculus mamillaris princeps, the corticospinal tract, the temporo-parietooccipito pontine tract, medial lemniscus, spinothalamic tract, mammillotegmental fasciculus, and dentatorubrothalamic tract were related with the posterolateral part of the hypothalamus. CONCLUSION: Understanding the detailed fiber tract anatomy of the hypothalamus would provide guidance to neurosurgeons in surgical planning, target selection for DBS and intraoperative orientation.