The contralateral transfalcine transprecuneus approach to the atrium of the lateral ventricle: operative technique and surgical results.

Abstract

BACKGROUND:

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.

• Authors: Tao Xie, Chongjing Sun, Xiaobiao Zhang, Wei Zhu, Jianping Zhang, Ye Gu, Wensheng Li
• Journal: Neurosurgery (Neurosurgery) Vol. 11 Suppl 2 Pg. 110-7; discussion 117-8 (Mar 2015) ISSN: 1524-4040 [Electronic] United States
• PMID: 25599208 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Brain Neoplasms (pathology, surgery)
• Female
• Humans
• Lateral Ventricles (surgery)
• Magnetic Resonance Angiography
• Middle Aged
• Neuronavigation (methods)
• Neurosurgical Procedures (methods)
• Retrospective Studies