Free Article: The Contralateral Transfalcine Transprecuneus Approach to the Atrium of the Lateral Ventricle

Screen Shot 2015-02-27 at 8.45.59 AMBACKGROUND: Surgical approaches to the atrium of the lateral ventricle remain a challenging neurosurgical issue because of the eloquent nature of the surrounding anatomy.

OBJECTIVE: To report our operative techniques and preliminary surgical results with the contralateral transfalcine transprecuneus approach.

METHODS: A retrospective data review was performed of patients undergoing a contralateral transfalcine transprecuneus approach for the resection of lesions in the atrium of the lateral ventricle. Patients were positioned in the prone position with a 30° elevation, and a 15° rotation was used. After a contralateral parasagittal parieto-occipital craniotomy and falx incision, the corticotomy in the contralateral precuneus gyrus created a corridor to the tumor. An endoscope was used to assist with the surgery.

RESULTS: Headache was the primary preoperative symptom, which improved in all patients after surgery. After treatment, symptoms were improved in all 3 patients with hemiparesis and in 3 of 6 patients with preexisting visual deficits; symptoms were unchanged in the other 3 patients with visual deficits during the 13- to 38-month follow-up. Nine lesions were totally removed, and 1 metastatic breast cancer lesion was subtotally removed; all patients had good neurological outcomes and no operative mortality.

CONCLUSION: The contralateral transfalcine transprecuneus approach is appropriate for most lesions in the atrium of the lateral ventricle. It provides a wider surgical angle (especially for the lateral extension) and reduces the risk of disturbance of the optic radiation compared with the conventional approaches. The use of magnetic resonance venography-magnetic resonance imaging neuronavigation makes the procedure much easier and more accurate, and the neuroendoscope adds to the visualization of the microscope and can reduce surgical complications.

From: The Contralateral Transfalcine Transprecuneus Approach to the Atrium of the Lateral Ventricle: Operative Technique and Surgical Results by Xie et al.

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