The Contralateral Transfalcine Transprecuneus Approach to the Atrium of the Lateral Ventricle: Operative Technique and Surgical Results. Issue 1 (16th January 2015)

• Record Type: Journal Article
• Authors: Xie, Tao; Sun, Chongjing; Zhang, Xiaobiao; Zhu, Wei; Zhang, Jianping; Gu, Ye; Li, Wensheng
• Is Part Of: Operative neurosurgery. Volume 11:Issue 1(2015)
• Page Start: 110
• Page End: 118
• Publication Date: 2015-01-16
• Subjects: Atrium -- Contralateral -- Lateral ventricle -- MRV -- Neuroendoscope, Surgical approach; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1227/NEU.0000000000000643
• Languages: English
• ISSNs: 2332-4252

Abstract

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.