The surgical anatomy of tentorial incisura

Objective. To determine the correlation between configuration and dimensions of tentorial incisura and craniometric indexes. Material and methods. We examined 100 anatomical specimens of tentorial incisura (TI). The measurement of longitudinal TI indexes, cranial indexes and angular parameters of cranial base relief was conducted. The morphometric analysis was performed with calculation of coefficients and indexes. Data processing was conducted using STATISTICA Statsoft. Microsurgical anatomy of incisural spaces of TI was studied using operative microscope МБС-10 and digital camera «Sony» HDR - CX 560 Е. Results. We distinguished 4 types of tentorial incisura configuration (А, В, С, D) based on the data of craniometric and morphometric analysis. It was stated that the mean values of TI parameters for mesocephalic cranium were determined by configuration of tentorial apex. Type А was characterized by pointed and tall apex, type B - by base and flat apex. TI was longer in the case of dolichocranial type comparing with other cranium types. The free edges of tentorium were more abrupt in the area of tentorial apex with minimal protrusion of upper vermis in posterior incisural space in the case of subbrachiocephaly. TI had small dimensions and width in the case of brachiocephaly. The algorithm of MRI data analysis for estimation of TI dimensions allowing predicting its configuration is defined. Conclusion. There are correlations between configuration of TI and cranium type. The suggested classification and morphometric analysis of TI configurations allows predicting TI shape at patients with oncologic and vascular brain pathology in preoperative period and justifying the adequacy of chosen surgical approach. The type of cerebral hernia depends on dimensions of anterior, middle and posterior parts of TI.

вырезка намета мозжечка, анатомическое исследование, морфометрический анализ, формы черепа, намет, верхушка намета, инцизуральные пространства вырезки намета мозжечка, tentorial incisure (TI), anatomical study, morphometric analysis, types of cranium configurations, tentorium, tentorial apex, incisural spaces of tentorial incisura

1. Крылов В.В. и соавт.: Хирургическое лечение больных с разрывами аневризм вертебробазилярного бассейна // Нейрохирургия. - 2010. - № 2. - С. 14-25.

2. Крылов В.В. Хирургия аневризм головного мозга. Под ред. члена-корреспондента РАМН проф. В.В. Крылова. В 3 т. М., 2011.

3. Крылов В.В. Микрохирургия аневризм головного мозга // под ред. проф. В.В. Крылова. - М., 2011.

4. Aziz А. Petroclival meningiomas: Predictive parameters for transpetrosal approaches. Neurosurgery 47: 139-152, 2000.

5. Adler D.E. The tentorial notch: anatomical variation, morphometric analysis, and classification in 100 human autopsy cases. J Neurosurg 96: 1103-1112, 2002.

6. Abuzayed В. Pneumatization degree of the anterior clinoid process: a new classification. Neurosurgical Review 33: 3, 367374. 1-Jul-2010.

7. Bambakidis N.C., Gonzalez F., Spetzler R.F. Combined skull base approaches to the posterior fossa. Technical note. Neurosurg Focus 19 (2): E8, 2005.

8. Colli В, Carlotti С.С. Results of microsurgical treatment of paraclinoid carotid aneurysms. Neurosurgical Review.: 17-Aug-2012.

9. Day J. Diaz. The Middle Fossa Approach and Extended Middle Fossa Approach. Neurosurgery 70, ons192-ons201. 1-Jun-2012.

10. Fukushima Т., Yoichi Nonaka. Fukushima Manual of Skull Base Dissection (Third Edition).: Text Copyright AF - Neuro Video, Inc.Printing: i WORD Co, LTD, pp-427, 2012.

11. Joo W., Funaki Т., Rhoton A.L. Jr. (2012) Microsurgical Anatomy of the Carotid Cave. Neurosurgery 70, ons 300-ons 312.: 1-Jun-2012.

12. Gonzalez L.F., Spetzler R.F. Skull base approaches to the basilar artery Neurosurg Focus 19 (2): E3, 2005.

13. Gross B.A., Tavanaiepour D., Al-Mefty O. Petrosal approaches to posterior circulation aneurysms Neurosurg Focus Aug 2012 / Vol. 33 / No. 2 / Page E9

14. Hanel R.A., Spetzler R.F. Surgical treatment of complex intracranial aneurysms. Neurosurgery 62 [Suppl]: 1289-1299, 2008.

15. Hsu F.P., Clatterbuck R.E., Spetzler R.F. Orbitozygomatic approach to basilar apex aneurysms. Neurosurgery 56: 172-177, 2005.

16. Hasegawa M. Anatomical Variaition of the Straigt Sinus //, Surg Neurrol 1991.

17. Kawase T. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas: Selective pyramid resection and radicality. Acta Neurochir. (Wien) 129: 113-120, 1994.

18. Kim Jae Min, Romano А. Microsurgical Anatomic Features and Nomenclature of the Paraclinoid Region. Neurosurgery 46: 3, 670-682.: 1-Mar-2000

19. Kobayashi S., Kyoshima K., Sugita K. Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70: 216-221, 1989.

20. Krisht Ali F. Transcavernous approach to diseases of the anterior upper third of the posterior fossa. Neurosurgical FOCUS 19: 2, 1-10. 1-Aug-2005.

21. Krisht Ali F., Kadri Р. Surgical Clipping of Complex Basilar Apex Aneurysms: A Strategy for Successful Outcome Using the Pretemporal Transzygomatic Transcavernous Approach. Neurosurgery 56: Supplement 2, 261-273.: 1-Apr-2005

22. Nathal Е. Surgical Treatment of Paraclinoid Aneurysms. 2012, 855-871.

23. Оnо M. Microsurgical anatomy of the region of the tentorial incisura. J. Neurosurg. 60: 365-399, 1984.

24. Rhoton A.L. Jr. Cranial Anatomy and surgical approaches, Neurosergery. Lippincott Williams & Wilkins, 746 pp, 2006.

25. Spetzler R.F., Daspit C.P. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 76: 588-599, 1992.

26. Sunderland S. The tentorial notch and complications produced by herniations of the brain through that aperture. Br J Surg 45: 422-438, 1958.

27. Yamamoto I., Kageyama N.: Microsurgery of the pineal region. J Neurosurg 53: 205-221, 1980.