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Stepwise Dissection of the Left Cerebral Hemisphere S-V

Surgical Correlation

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S, A retractor has been placed between the thalamus and the crus of the fornix to open the choroidal fissure. Opening the choroidal fissure in the body of the ventricle exposes the third ventricle. Opening the choroidal fissure between the pulvinar and crus of the fornix exposes the quadrigeminal cistern, and opening the fissure between the lower surface of the thalamus and the fimbria of the fornix exposes the ambient cistern. T, The remaining insula has been removed to expose the thalamus forming the inner rim of the choroidal fissure. The lateral geniculate body is exposed at the lower margin of the thalamus. The optic radiations pass laterally above the hippocampus in the roof of the temporal horn and posteriorly around the lateral margin at the atrium to reach the calcarine sulcus. The anterior wall of the temporal horn is formed by the amygdala, which tilts backward above, but is separated from the hippocampal head by the temporal horn. U, The thalamus has been removed to expose the third ventricle. The body, crus, and fimbria of the fornix, forming the outer margin of the choroidal fissure, have been preserved. Opening the choroidal fissure in front of the crus of the fornix exposes the pineal region and quadrigeminal cistern. Opening the choroidal fissure adjacent to the body of the fornix exposes the third ventricle. Opening the choroidal fissure in the temporal horn exposes the ambient cistern and posterior cerebral arteries. The medial posterior choroidal arteries are exposed in the quadrigeminal cistern. The striae medullaris thalami marks the lower edge of the velum interpositum, in which the internal cerebral veins course. V, The left half of the body of the fornix has been folded downward to expose the right half of the body and medial aspect of the contralateral choroidal fissure located between the body of the fornix and the upper surface of the thalamus. The pineal gland and posterior commissure are exposed at the posterior margin and the anterior commissure and columns of the fornix are exposed at the anterior margin of the third ventricle. (Images courtesy of AL Rhoton, Jr.)

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