Parietal penceredeki sulkal ve gyral yapıların kraniumdaki topografik noktalara göre konumu
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Date
2007
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Tıp Fakültesi
Abstract
SUMMARY SULCAL AND GYRAL STRUCTURES IN PARIETAL WINDOW AND THEIR LOCATIONS IN RELATION WITH CRANIAL TOPOGRAFIC POINTS The knowledge of projections of gyral and sulcal structures of the brain to the cranium is necessary to decrease the complications during neurosurgical operations or minimal invasive interventions. The relation of suical and gyral structures to the bony structures was not investigated in details in recent studies. In this study, we aimed to focus on the parietal region which is an important center for surgical procedures. We therefore examined this region comprehensively to obtain the practical information and provide better adaptation for neurosurgical operations. This study was performed on 9 formaline fixed non-autopsied cadaveric heads. The scalp was dissected and the sutures of cranium and the craniometrical points were exposed. The sutures of the skull were protected by making windows with assistance of high speed drill. The gyruses (gyri) and sulcuses (sulci) located in parietal window and their relations with bone structures were determined. The points connecting the sulci were evaluated in details in reference to bony structures. The locations of sulci and gyri were described in relation to parietal window. All the measurements were performed in reference to borders of the parietal window. The structures located in the first quarter of the window are: SFG, SFS, MFG, IFS, opercular part of IFG, PreS and PreG were located, in the second quarter: Cents, PostG, Posts, SPL, IntS, SMG and posterior branch of LatS, in the third quarter: SPL, IntS, CinS, SMG, AG, STS and STG, in the fourth quarter: SPL, IntS, AG, ParocS, Preocl and OL. The SFS and PreS intersected with each other in 14 out of 18 hemispheres. This intersection point was found to be 3.54 cm laterally to the SS and 2.13 posteriorly to SC. The distance between the starting point of Cents and the 118CS was measured as 5.56 cm. These two points were landmarks and borders of orientation in superior frontal and central craniotomies. We suggest that during transsulcal, transgyral and frontal interhemispheric approaches to anterior ventricular lesions measuring these distances will be useful. The distance between Cents and CS was equal to the paracentral lobule and it is measured as 2.65 cm. Since the paracentral lobule is one of the most commonly damaged areas, PostG and PreG and the distance in between will be important foe central craniotomies. The IFS was observed to intersect with the PreS in 14 out of 18 hemispheres. This point is observed to be located below the St. This point is important since it helps to provide orientation for pterional or for developed frontotemporal craniotomies based on frontotemporosphenoidal craniotomies. The Posts was found to be intersect with IntS in 12 out of 18 hemispheres. This point was located 5,01 cm lateral to SS and 6,84 cm posterior to the bregma. The distance of beginning point of PorocS to the La was measured as 0,98 cm. The SMG was found to be below the tuber parietale (euryon) in 14 out of 18 hemispheres.The knowledge of the point where IntS-PostS intersects and where ParocS starts is important for decreasing the complications during parietal craniotomies. The results of this study represent detailed knowledge of measurements of sulcuses used as reliable microsurgical corridors during frontotemporal and parietal craniotomies. The clinical relevance of the results obtained in this study and their contribution during surgical approaches has been discussed in details. The practical data obtained in this study provides an orientation to the surface and deep structures therefore it helps localizing the lesions with imaging techniques and they may be useful to decrease the complications.
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Keywords
Parietal bölge, sulkus, gyrus, kranium, kraniyomertrik noktalar, Parietal region, sulcus, gyrus, cranium, craniometric points