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J Neurol Surg A Cent Eur Neurosurg 2013; 74(04): 228-233
DOI: 10.1055/s-0033-1341414
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Entry Point to the Sylvian Fissure for the Pterional Transsylvian Approach

H. Yamahata
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
,
H. Tokimura
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
,
K. Hirahara
2   Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan
,
T. Ishii
2   Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan
,
T. Hanada
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
,
H. Hirano
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
,
R. Hanaya
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
,
S. Sugata
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
,
K. Mamitsuka
3   Department of Neurosurgery, Fujimoto Hayasuzu Hospital, Miyakonojo, Japan
,
K. Arita
1   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
› Author Affiliations
Further Information

Publication History

17 February 2012

20 December 2012

Publication Date:
22 March 2013 (online)

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Abstract

Background Although the anatomy of the Sylvian fissure is understood, there is little information on where to start its dissection in the pterional transsylvian (PT-TS) approach. At small craniotomy using the PT-TS approach, we set the entry point to the Sylvian fissure at 15 mm behind the anterior edge of the craniotomy along the Sylvian fissure and designated this site “point 15.” Here we compared the utility of “point 15” with the Sylvian point (point on the Sylvian fissure giving rise to the horizontal and anterior ascending rami) that had been recommended earlier as the entry site for opening the Sylvian fissure.

Materials and Methods This study includes 16 patients with 7 ruptured and 9 unruptured anterior circulation aneurysms. We evaluated the usefulness of “point 15” in the PT-TS approach for aneurysmal neck clipping with respect to the adequacy of anatomical exposure and low invasiveness.

Results In 12 patients “point 15” provided for excellent anatomical exposure of the Sylvian fissure; complete neck clipping was possible with minimal brain retraction and damage. In two patients with ruptured aneurysms and thick subarachnoid hemorrhage and in two patients with unruptured aneurysms, the dissection had to be enlarged 3 to 4 mm distally without reaching the Sylvian point. In the latter two patients the Sylvian veins were tethered to frontal and temporal lobes.

Conclusions The “point 15” was an easily set entry point to the Sylvian fissure. It provided for sufficient anatomical exposure at surgery for anterior circulation aneurysms; additional posterior dissection was required in rare cases. We found that “point 15” was useful in small craniotomies using the PT-TS approach.

Keywords

sylvian fissure - transsylvian approach - sylvian vein - entry point - sylvian point
 

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