Surgical Approaches to Intraventricular Meningiomas of the Trigone

Jun, Cecil; Nutik, Stephen L.

doi:10.1227/00006123-198503000-00025

Cited by 69 publications

(42 citation statements)

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“…13,25,31 Other surgeons advocated the posterior middle temporal gyrus approach. 3,11,14,15,28 This approach permits an early access to anterior choroidal arteries and good exposure to tumors extending into the temporal horn; however, the risks include injury to the optic radiations and language deficits in the dominant hemisphere. 21 Other risks of the transtemporal approach include aphasia, agraphia and alexia, and visual spatial apraxia.…”

Section: Discussionmentioning

confidence: 99%

“…Current morbidity rates with the use of neuronavigation for transtemporal routes range from 0-20%. 12 Yasargil and Menon 11 preferred an ipsilateral parietooccipital interhemispheric approach.…”

Section: Discussionmentioning

confidence: 99%

“…21 Others have recommended use of the posterior transcallosal approach. 11,15,28 McDermott 20 developed a modification of this route using a contralateral transcallosal trajectory. 20 He described transection of the inferior 1-2/3 of the falx and inferior sagittal sinus followed by no more than a 2-cm callosotomy.…”

Section: Discussionmentioning

confidence: 99%

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Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes

Bohnstedt¹,

Kulwin²,

Shah³

et al. 2015

JNS

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OBJECT Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route. METHODS Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed. RESULTS The mean age of patients at the time of surgery was 39 years (range 11–64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5–19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5. CONCLUSIONS Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes

Bohnstedt¹,

Kulwin²,

Shah³

et al. 2015

JNS

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“…No solitary middle fossa approach will permit early control of both anterior and posterior choroidal arteries, initially. 21 Anatomically, the structures that must be respected during removal of temporal horn tumors include the medial structures such as the hippocampus and its projections, temporal stem, PCA, anterior choroidal artery, and brainstem. Superiorly, one must avoid the optic tract, the Meyer-Archambault loop, and arcuate fasciculus.…”

Section: Neurosurgical Focus / Volume 10 / June 2001mentioning

confidence: 99%

“…11,48 Carrying the lobectomy too far forward can cause dyslexia. 21 Hécaen, et al, 18 have described the occurrence of total alexia in seven patients in whom occipital lobectomy was performed. This is a significant clinical deficit similar to that reported by Van Buren 49 after performing an occipital lobectomy in the dominant hemisphere.…”

mentioning

confidence: 99%

Transcortical surgery for lateral ventricular tumors

Ellenbogen

2001

FOC

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Object Tumors of the lateral ventricle can be removed via two major approaches: the transcallosal or the transcortical route. The purpose of this study is to discuss the techniques and outcomes in transcortical surgery of tumors located in the lateral ventricle. Methods An experience with 29 consecutive lateral ventricular tumors resected via the transcortical route, over a 5-year period, is presented. The risks, complications, and outcomes of this surgical series, as well as those reported in the literature, are discussed. Surgical approaches to all five regions of the lateral ventricle are described. Neuropsychological, functional, and neurological outcomes are evaluated. Conclusions The transcortical technique makes it possible to resect lesions in each of the five regions of the lateral ventricle. It provides superior microsurgical working space and flexibility for maneuvering within the lateral ventricle. The key to a successful transcortical approach is an understanding of the functional anatomy of eloquent cortex to be broached, the location of the lesion, and its vascular supply. A clear understanding of the advantages and limitations of the transcortical approach makes performing this procedure for resection of large lesions in the ventricle both safe and effective. The majority of the patients in this series (86%) had a good outcome, returning to baseline functional status and suffering minimal morbidity. In the microsurgical era, transcortical surgery–related postoperative morbidity and outcome are dependent more on tumor histological type and site of origin than on approach.

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