{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:00:57Z","timestamp":1790388057253,"version":"4.1.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Lesions in or around the atrium pose a surgical challenge due to their deep location and proximity to eloquent cortical and subcortical structures. Hence, a handful of approaches have been proposed aiming to minimize parenchymal transgression while providing adequate surgical maneuverability and dexterity. To this end, the authors sought to evaluate, for the first time in the pertinent literature, the feasibility of the intraoccipital sulcus (IOS) as a natural corridor to access the atrium safely and effectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Twenty formalin-fixed adult cerebral hemispheres treated with the Klingler\u2019s technique were investigated. The morphology of the IOS was recorded, and the subcortical anatomy lining the corridor from the sulcal fundus to the atrium was explored through focused lateromedial white matter dissections. Additionally, 20 T2-weighted multiplanar reconstructions (MPRs) from the HCP Young Adult dataset were analyzed to quantify the \"angle of attack\" toward the atrium. Then the respective distances of the IOS and intraparietal sulcus (IPS) from the midline were compared to evaluate whether an IOS-based trajectory permits access to the atrial roof rather than the lateral wall. T2-weighted MR images from a cohort of 25 healthy individuals were also included to record the IOS surface anatomy, sulcal length, and fundus-to-atrium depth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The IOS was consistently recorded and found to be continuous with the IPS in most cases. Its mean length and depth were approximately 2.2 cm and 1.1 cm, respectively, and the mean sulcal fundus-to-atrium distance was 1.90 cm. MPR analysis showed that the anterior IOS segment offers an almost perpendicular trajectory to the atrium and lies medial to the IPS, thus allowing entrance to the atrial roof. The white matter transgression en route to the ventricle disrupts the fibers of the vertical occipital fasciculus while causing minimal injury to the posterior part of the sagittal stratum. The approach avoids the optic pathway since it allows entering the atrium through its roof.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>An IOS transsulcal corridor provides a practical, safe, and effective pathway to the roof of the atrium as it minimizes transgression of eloquent fiber tracts and respects the optic radiations. Combined cadaveric and MRI evidence supports the IOS as a reliable planning landmark for selected atrial and periatrial lesions; however, prospective clinical validation is still needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.3.jns252569","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:28Z","timestamp":1785283288000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["Navigating the atrium: leveraging the intraoccipital sulcus as a natural corridor for safe access. A sulcal and subcortical architectural analysis"],"prefix":"10.3171","author":[{"given":"Lykourgos","family":"Anastasopoulos","sequence":"first","affiliation":[{"name":"Neurosurgical Department, Evangelismos General Hospital, Athens;"},{"name":"Athens Microneurosurgery Laboratory, Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Charalampopoulou","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Evangelismos General Hospital, Athens;"},{"name":"Athens Microneurosurgery Laboratory, Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Neromyliotis","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Evangelismos General Hospital, Athens;"},{"name":"Athens Microneurosurgery Laboratory, Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Drosos","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios P.","family":"Skandalakis","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristotelis V.","family":"Kalyvas","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Athens;"},{"name":"Neurosurgical Department, Attikon University Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Troupis","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Medical School, University of Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lampis C.","family":"Stavrinou","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Attikon University Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Stranjalis","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Evangelismos General Hospital, Athens;"},{"name":"Athens Microneurosurgery Laboratory, Athens;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutsarnakis","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Athens;"},{"name":"Neurosurgical Department, Red Cross, General Hospital of Athens; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Nat Rev Neurol","first-page":"255","article-title":"Stimulation mapping of white matter tracts to study brain functional connectivity","volume":"11","author":"Duffau H","year":"2015","unstructured":"Duffau H. 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Neurosurgery. 2008;62(6):SHC1029\u2013SHC1041. doi:10.1227\/01.NEU.0000316427.57165.01"},{"issue":"4","key":"b4","series-title":"Oper Neurosurg","first-page":"503","article-title":"Approaching the atrium through the intraparietal sulcus: mapping the sulcal morphology and correlating the surgical corridor to underlying fiber tracts","volume":"13","author":"Koutsarnakis C","year":"2017","unstructured":"Koutsarnakis C, Liakos F, Kalyvas AV,  Approaching the atrium through the intraparietal sulcus: mapping the sulcal morphology and correlating the surgical corridor to underlying fiber tracts. Oper Neurosurg. 2017;13(4):503\u2013516. doi:10.1093\/ons\/opw037"},{"key":"b5","series-title":"World Neurosurg","first-page":"339","article-title":"The superior frontal transsulcal approach to the anterior ventricular system: exploring the sulcal and subcortical anatomy using anatomic dissections and diffusion tensor imaging tractography","volume":"106","author":"Koutsarnakis C","year":"2017","unstructured":"Koutsarnakis C, Liakos F, Kalyvas AV,  The superior frontal transsulcal approach to the anterior ventricular system: exploring the sulcal and subcortical anatomy using anatomic dissections and diffusion tensor imaging tractography. World Neurosurg. 2017;106:339\u2013354. doi:10.1016\/j.wneu.2017.06.161"},{"issue":"2 suppl","key":"b6","series-title":"Operative Neurosurgery","first-page":"E438","article-title":"Lateral transsulcal approach to asymptomatic trigonal meningiomas with correlative microsurgical anatomy: technical case report","volume":"56","author":"Nagata S","year":"2005","unstructured":"Nagata S, Sasaki T. Lateral transsulcal approach to asymptomatic trigonal meningiomas with correlative microsurgical anatomy: technical case report. Operative Neurosurgery. 2005;56(2 suppl):E438. doi:10.1227\/01.neu.0000156553.94932.dd"},{"issue":"5","key":"b7","series-title":"Neurosurgery","first-page":"651","article-title":"The surgical anatomy of the cerebral sulci","volume":"24","author":"Harkey HL","year":"1989","unstructured":"Harkey HL, Al-Mefty O, Haines DE, Smith RR. The surgical anatomy of the cerebral sulci. Neurosurgery. 1989;24(5):651\u2013654. doi:10.1227\/00006123-198905000-00001"},{"issue":"1","key":"b8","series-title":"Neurosurg Rev","first-page":"335","article-title":"Mapping the superficial morphology of the occipital lobe: proposal of a universal nomenclature for clinical and anatomical use","volume":"44","author":"Koutsarnakis C","year":"2021","unstructured":"Koutsarnakis C, Komaitis S, Drosos E,  Mapping the superficial morphology of the occipital lobe: proposal of a universal nomenclature for clinical and anatomical use. Neurosurg Rev. 2021;44(1):335\u2013350. doi:10.1007\/s10143-019-01212-2"},{"key":"b9","series-title":"Front Neurol","first-page":"794618","article-title":"Superior longitudinal fasciculus: a review of the anatomical descriptions with functional correlates","volume":"13","author":"Janelle F","year":"2022","unstructured":"Janelle F, Iorio-Morin C, D\u2019amour S, Fortin D. 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Cereb Cortex. 2017;27(6):3346\u20133359. doi:10.1093\/cercor\/bhx070"},{"issue":"1","key":"b21","series-title":"Brain Struct Funct","first-page":"85","article-title":"Mapping the human middle longitudinal fasciculus through a focused anatomo-imaging study: shifting the paradigm of its segmentation and connectivity pattern","volume":"225","author":"Kalyvas A","year":"2020","unstructured":"Kalyvas A, Koutsarnakis C, Komaitis S,  Mapping the human middle longitudinal fasciculus through a focused anatomo-imaging study: shifting the paradigm of its segmentation and connectivity pattern. Brain Struct Funct. 2020;225(1):85\u2013119. doi:10.1007\/s00429-019-01987-6"},{"issue":"6","key":"b22","series-title":"J Neurosurg Sci","first-page":"605","article-title":"The inferior fronto-occipital fascicle: a century of controversies from anatomy theaters to operative neurosurgery","volume":"65","author":"De Benedictis A","year":"2021","unstructured":"De Benedictis A, Marras CE, Petit L, Sarubbo S. 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Brain Struct Funct. 2013;218(1):21\u201337. doi:10.1007\/s00429-011-0372-3"},{"issue":"suppl 5","key":"b24","series-title":"J Neurol Neurosurg Psychiatry","first-page":"v25","article-title":"Apraxia, agnosias, and higher visual function abnormalities","volume":"76","author":"Greene JDW","year":"2005","unstructured":"Greene JDW. Apraxia, agnosias, and higher visual function abnormalities. J Neurol Neurosurg Psychiatry. 2005;76(suppl 5):v25\u2013v34. doi:10.1136\/jnnp.2005.081885"},{"issue":"10","key":"b25","series-title":"Nat Neurosci","first-page":"1245","article-title":"A lateralized brain network for visuospatial attention","volume":"14","author":"de Schotten MT","year":"2011","unstructured":"de Schotten MT, Dell\u2019Acqua F, Forkel SJ,  A lateralized brain network for visuospatial attention. 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Ann Neurol. 2005;57(1):8\u201316. doi:10.1002\/ana.20319"},{"issue":"1-2","key":"b28","series-title":"Cognition","first-page":"67","article-title":"Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language","volume":"92","author":"Hickok G","year":"2004","unstructured":"Hickok G, Poeppel D. Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language. Cognition. 2004;92(1-2):67\u201399. doi:10.1016\/j.cognition.2003.10.011"},{"key":"b29","series-title":"Front Hum Neurosci","first-page":"890483","article-title":"Phonological working memory representations in the left inferior parietal lobe in the face of distraction and neural stimulation","volume":"16","author":"Yue Q","year":"2022","unstructured":"Yue Q, Martin RC. Phonological working memory representations in the left inferior parietal lobe in the face of distraction and neural stimulation. Front Hum Neurosci. 2022;16:890483. doi:10.3389\/fnhum.2022.890483"},{"issue":"5","key":"b30","series-title":"Neuropsychology","first-page":"529","article-title":"The role of inferior parietal and inferior frontal cortex in working memory","volume":"20","author":"Baldo JV","year":"2006","unstructured":"Baldo JV, Dronkers NF. The role of inferior parietal and inferior frontal cortex in working memory. Neuropsychology. 2006;20(5):529\u2013538. doi:10.1037\/0894-4105.20.5.529"},{"key":"b31","series-title":"World Neurosurg","first-page":"556","article-title":"Minimally invasive transsulcal resection of intraventricular and periventricular lesions through a tubular retractor system: multicentric experience and results","volume":"90","author":"Eliyas JK","year":"2016","unstructured":"Eliyas JK, Glynn R, Kulwin CG,  Minimally invasive transsulcal resection of intraventricular and periventricular lesions through a tubular retractor system: multicentric experience and results. 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