Contralateral Transfalcine Versus Ipsilateral Anterior Interhemispheric Approach for Midline Arteriovenous Malformations: Surgical and Anatomical Assessment.
Contralateral Transfalcine Versus Ipsilateral Anterior Interhemispheric Approach for Midline Arteriovenous Malformations: Surgical and Anatomical Assessment.
复制标题
对侧经大脑镰与同侧前纵裂入路治疗中线动静脉畸形：手术和解剖评估。
DOI：
10.1016/j.wneu.2018.08.074
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发表时间：
2018
影响因子：
2
通讯作者：
Benet,Arnau
中科院分区：
文献类型：
--
作者：
García-García,Sergio;González-Sánchez,JoséJuan;Gandhi,Sirin;Tabani,Halima;Meybodi,AliTayebi;Kakaizada,Sofia;Lawton,MichaelT;Benet,Arnau
背景：对侧前半球间入路（CAIA）被认为提供了进入深中线病变的手术优势：更宽的工作角度，重力增强的解剖和后收，更有效的照明和人体工程学。我们的团队先前发表了使用对侧轨迹治疗内侧额顶叶动静脉畸形（AVMs）与传统的前半球间入路（IAIA）相比的优点。在这篇文章中，我们比较了IAIA和CAIA切除内侧额顶叶动静脉畸形的定量手术和解剖分析。方法设计两种模型，模拟中线动静脉畸形最常见的特征。10例标本双侧行CAIA和IAIA。使用立体定向导航独立评估比较技术可行性的变量（手术窗口[SW]和手术自由度[SF]、靶暴露和攻角）。平均西南偏角、SF和攻角与Studentttest进行比较。显著性阈值设为0.05。结果CITA和IAIA在AVM上侧的SW、靶暴露和SF方面相似。在两种AVM模型的半球间裂深度上，CAIA均显著优于IAIA: AVM下侧AA宽77% (P< 0.01)，引流静脉SF宽54% (P = 0.01)，同侧ACA宽98% (P = 0.02)，对侧ACA宽117% （P< 0.01）。结论本研究提示CAIA在深中线avm切除术中的技术优势。在我们的模型中，浅表区域没有客观差异，表明IAIA是浅表avm更安全的选择。我们的结果为进一步的临床分析奠定了基础。
BackgroundThe contralateral anterior interhemispheric approach (CAIA) is considered to provide surgical advantages to access deep midline lesions: wider working angle, gravity enhanced dissection and retraction, more efficient lighting, and ergonomics. Our team has previously published on the merits of using a contralateral trajectory for medial frontoparietal arteriovenous malformations (AVMs) compared with the conventional anterior interhemispheric approach (IAIA). In this article, we compare the IAIA and CAIA for the resection of medial frontoparietal AVMs using quantitative surgical and anatomical analysis.MethodsTwo models were designed mimicking the most common features of midline AVMs. The CAIA and IAIA were performed bilaterally in 10 specimens. Variables to compare technical feasibility (surgical window [SW] and surgical freedom [SF], target exposure, and angle of attack) were independently assessed using stereotactic navigation. The average SW, SF, and angle of attack were compared with the Studentttest. Significance threshold was set at 0.05.ResultsThe CITA and IAIA were similar in terms of SW, target exposure, and SF in the superior aspect of the AVM. In the depth of the interhemispheric fissure, the CAIA was significantly superior to IAIA in both AVM models: 77% wider AA for the inferior aspect of the AVM (P< 0.01) and greater SF for the draining vein (54%,P= 0.01), ipsilateral (98%,P= 0.02), and contralateral ACA (117%,P< 0.01).ConclusionsThis study suggests technical superiority of the CAIA for the resection of deep midline AVMs. No objective difference was noted in the superficial areas of our models, denoting that IAIA is a safer choice for superficial AVMs. Our results set the foundation for further clinical analysis comparing both approaches.