Ahead of Print: Keyhole STTCS Approach

Screen Shot 2013-04-29 at 9.33.03 AMBackground and Importance: Meningiomas of the lateral ventricles are commonly located in the atria. Surgical access to such tumors is challenging because of their deep location and proximity to critical neurovascular structures, particularly if situated on the dominant side. Although a number of approaches have been described in the literature, most carry the risk of post-operative neuropsychological, visual or speech deficits, especially when operating on the dominant hemisphere. The supracerebellar transtentorial transcollateral sulcus (STTCS) approach offers the potential to circumvent functionally important structures, reducing the risk of these approach-related neurological deficits.

Clinical Presentation: Two patients with dominant hemisphere trigonal meningiomas underwent surgical resection utilizing the STTCS approach. Neuronavigation was used to carefully plan the incision, craniotomy and exposure, and also intra-operatively to orientate the operating surgeon at key steps, particularly when raising the tentorial flap in-line with the tumor. Endoscopy was used to provide increased light intensity, an extended viewing angle, and higher magnification when compared to a microscope. Specially designed tube-shaft instruments were also employed to assist with manipulation through the narrow surgical corridor. In both cases the tumors were fully resected without approach-related morbidity.

Conclusion: The STTCS approach provides good access to tumors located in the trigonal region, reducing the risk of iatrogenic language or visual field deficits. In dominant hemisphere lesions, in the hands of an experienced neurosurgeon, the SCTT approach is an effective alternative to existing techniques.

From: Keyhole Supracerebellar Transtentorial Transcollateral Sulcus Approach to the Lateral Ventricle by Marcus et al.

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