Trans-sulcal or fissure approach for supratentorial brain lesions: evaluation

Abstract

Object: To evaluate the efficacy and safety of trans-sulcal or fissure approach in surgical treatment of supratentorial lesions Study design: Retrospective clinical case series Methods: This study included 42 patients. Age ranged from 4 to 78 years. Sulcal dissection was done in 26 patients at or near the eloquent areas, and in 16 patients, it was done in non-eloquent areas. Diffusion tensor tractography, neuronavigation, and intraoperative monitoring were applied for lesions at the motor areas. The follow-up period was 24 months. Results: Gross total excision could be achieved in 52% of patients. Sulcal dissection was easy in 26 patients with the lax brain. The outcome, according to the Karnofsky scale, was 100 in 21/42 (50%). Complications were transient deterioration of function in three patients, and immediate post-operative hemorrhage in two patients. Three patients became seizure-free after surgery. Conclusion: The trans-sulcal dissection is a safe, useful, and applicable approach. Through which it is possible to reach deeply seated lesions. It preserves the motor functions, provides wider exposure, minimizes the need of brain retraction during surgery, and preserves the gyral layers. Complications are usually transient, specially in the presence of preoperative diffusion tensor tractography, intraoperative neuronavigation, and monitoring.

Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas

“…Furthermore, many lesions had significant reduction in large collections of vasogenic edema as noted in both illustrative cases, potentially enhancing functional recovery ( Figure 4 and Figure 5 ). With these factors in mind, the data represents similar or greater GTR and postoperative improvements when compared to other TScal literature [ 48 , 50 , 51 , 52 ].…”

“…Farid et al followed by reporting their experiences in 42 patients for non-eloquent and 26 eloquent lesions in 2019. Farid’s team reported a GTR rate of 52%, but improvement in preoperative deficits or development new of postoperative neurologic sequelae were not documented [ 48 ].…”

Deep motor cortex cavernoma resection supported by navigational intraoperative monitoring

“…Dispensing brain retraction by dissecting the normal brain pathways is safer for gyral layers and confers motor function preservation. No serious complications of the trans-sulcal approach are reported especially with pre-operative MRI, IONM, intraoperative neuronavigation, and brain mapping [3].…”