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    In Reply: Opening the Parieto-Occipital Fissure for Periatrial Metastasis: 2-Dimensional Operative Video
    (Lippincott Williams & Wilkins, 2024) Dogruel, Yucel; Rahmanov, Serdar; Gungor, Abuzer; Ture, Ugur
    [Abstract Not Available]
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    Microsurgical Resection of a Parachiasmatic Craniopharyngioma via a Left-Sided Pterional Transsylvian Approach
    (Elsevier Science Inc, 2024) Dogruel, Yucel; Rahmanov, Serdar; Gungor, Abuzer; Ture, Ugur
    Craniopharyngiomas are histologically benign tumors that originate from squamous rests along the pituitary stalk. They make up approximately 1.2% to 4.6% of all intracranial tumors and do not show significant differences in occurrence based on sex. Adamantinomatous craniopharyngiomas have 2 peaks of incidence, commonly observed in patients from ages 5 to 15 years and again from 45 to 60 years. In contrast, papillary craniopharyngiomas mainly affect adults in their fifth and sixth decades of life.1 The malignancy of craniopharyngiomas is attributed to their location and the challenges associated with achieving complete removal because they can manifest in the sellar, parachiasmatic, and intraventricular regions or a combination of these.2,3 Various approaches have been used to resect these tumors.4,5 Radical resection offers the most promising option for disease control, potential cure, and the ability to transform the disease from lethal to survivable in children, allowing for a functional adult life.2,3 Meticulous evaluation is crucial to determine the appropriate approach and side, with particular emphasis on closely examining the relationship between the tumor and optic pathways (nerve, chiasm, tract), which are frequently involved. This assessment should also include the tumor's relationship with other crucial structures, such as the hypothalamus and adjacent arteries, to ensure that the strategy is adjusted accordingly to further minimize the risk of postoperative morbidity. Video 1 demonstrates a left -sided pterional transsylvian approach to remove a parachiasmatic craniopharyngioma involving the left optic chiasm and tract.
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    Opening the Parieto-Occipital Fissure for Periatrial Metastasis: 2-Dimensional Operative Video
    (Lippincott Williams & Wilkins, 2024) Dogruel, Yucel; Rahmanov, Serdar; Gungor, Abuzer; Ture, Ugur
    [Abstract Not Available]
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    Osteoplastic Pterional Craniotomy: Success Rate of Surgery in Patient Aspect
    (Turkish Neurosurgical Soc, 2023) Varol, Eyup; Avci, Furkan; Etli, Mustafa Umut; Ramazanoglu, Ali Fatih; Aydin, Serdar Onur; Gungor, Abuzer; Onen, Mehmet Resit
    AIM: To evaluate the effect of osteoplastic pterional craniotomy on temporal hollowing and its sequelae.MATERIAL and METHODS: A total of 97 patients who underwent pterional craniotomy for an aneurysm were analyzed retrospectively. Of these 97 patients, 63 underwent surgery via the conventional pterional approach and 34 underwent surgery via the osteoplastic pterional approach. The temporal muscle volume was calculated bilaterally on CT images obtained in the sixth postoperative month. The results obtained in the conventional and osteoplastic approaches were compared.RESULTS: Of the 97 included patients, 45 were female and 52 were male. The mean patient age was 50.37 years. In the conventional group, 31 were female and 32 were male. In the osteoplastic group, 14 were female and 20 were male. The temporal muscle volume difference between the operated and non-operated side was not statistically significant in the osteoplastic group. However, the volume was slightly lesser on the operated side than on the non-operated side in the conventional group.CONCLUSION: The osteoplastic pterional approach is superior to the conventional approach in preserving the muscle volume and function. Patients who underwent osteoplastic craniotomy demonstrated higher levels of satisfaction with their facial appearance compared to those who underwent craniotomy using the conventional pterional approach.
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    Posterior Interhemispheric Transtentorial Subsplenial Approach for Posterior Thalamic Tumors: 2-Dimensional Operative Video
    (Lippincott Williams & Wilkins, 2024) Dogruel, Yuecel; Rahmanov, Serdar; Gungor, Abuzer; Ture, Ugur
    INDICATIONS: CORRIDOR AND LIMITS OF EXPOSURE:The posterior interhemispheric transtentorial subsplenial approach provides a direct corridor to posterior thalamic lesions without a cortical or callosal incision.1 ANATOMIC ESSENTIALS: NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT:This corridor is through the posterior interhemispheric fissure along the medial surface of the cuneus and allows the subsplenial region to be explored. Evaluating the tumor's size and extension is crucial to determining the suitability of this approach. The deep venous system may be displaced from mass effect, requiring preoperative venous examination. ESSENTIALS STEPS OF THE PROCEDURE:A 34-year-old male patient was admitted elsewhere with blurred vision and imbalance. MRI revealed a right-sided posterior thalamic tumor with heterogeneous contrast enhancement. The patient was followed-up after placement of a ventriculoperitoneal shunt. Seven months later, he was admitted to our clinic because the tumor had grown. The patient underwent surgical intervention. The patient was placed in the prone oblique position. After dural opening, the quadrigeminal cistern was opened to release cerebrospinal fluid, allowing significant gravity relaxation of the ipsilateral hemisphere. The tentorium was cut and retracted to achieve the necessary exposure. PITFALLS/AVOIDANCE OF COMPLICATIONS:The most serious complications of this approach occur from vascular injuries. Gravitational retraction of the occipital lobe protects the optic radiation, and anatomic landmarks help the surgeon maintain anatomic orientation. VARIANTS AND INDICATIONS FOR THEIR USE:The perimedian supracerebellar transtentorial approach is an alternative to the posterior interhemispheric transtentorial subsplenial approach for lesions in this area; however, the indications and limits of these approaches have some differences.The patient consented to the procedure and to the publication of his/her image.Images at 0:29 reused from Serra et al,1 with permission from Elsevier. VARIANTS AND INDICATIONS FOR THEIR USE:The perimedian supracerebellar transtentorial approach is an alternative to the posterior interhemispheric transtentorial subsplenial approach for lesions in this area; however, the indications and limits of these approaches have some differences.The patient consented to the procedure and to the publication of his/her image.Images at 0:29 reused from Serra et al,1 with permission from Elsevier. VARIANTS AND INDICATIONS FOR THEIR USE:The perimedian supracerebellar transtentorial approach is an alternative to the posterior interhemispheric transtentorial subsplenial approach for lesions in this area; however, the indications and limits of these approaches have some differences.The patient consented to the procedure and to the publication of his/her image.Images at 0:29 reused from Serra et al,1 with permission from Elsevier.
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    Revealing the confusion of the evolution of the term sagittal stratum. Historical overview and systematic literature review
    (Elsevier Masson, Corp Off, 2024) Gulsuna, Beste; Gungor, Abuzer; Borcer, Alp O.; Ture, Ugur
    The fiber dissection technique is one of the earliest methods used to demonstrate the in-ternal structures of the brain, but until the development of fiber tractography, most neuroanatomy studies were related to the cerebral cortex and less attention was given to the white matter. During the historical evolution of white matter dissection, debates have arisen about tissue preservation methods, dissection methodology, nomenclature, and efforts to adopt findings from primates to the human brain. Since its first description, the sagittal stratum has been one of the white matter structures subject to controversy and has not been sufficiently considered in the literature. With recent functional studies suggesting potential functions of the sagittal stratum, the importance of attaining a precise under-standing of this structure and its constituent fiber tracts is further highlighted. This study revisits the historical background of white matter dissection, unveils the early synony-mous descriptions of the sagittal stratum, and provides a systematic review of the current literature. Through evaluation of the historical statements about the sagittal stratum, we provide an understanding of the divergence and explain the reasons for the ambiguity. We believe that acquiring such an understanding will lead to further investigations on this subject, which has the potential to benefit in addressing various neuropsychiatric condi-tions, maintaining functional connectivity, and optimizing surgical outcomes.(c) 2023 Elsevier Ltd. All rights reserved.