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The transylvian trans-insular approach to lateral thalamic lesions
Shashwat Mishra1, Ramesh C Mishra
1Department of Neurosurgery, Neurosurgical Clinics, Kamayani Hospital, Agra, India.
Background:
Thalamic tumors are rare intracranial tumors. The most common approaches to the thalamus have been directed through the ventricular system, which surrounds it. The transsylvian trans-insular approach to the lateral thalamus has been infrequently described probably because of the vulnerability of the internal capsule, which skirts this part of the thalamus.
Aims:
To describe the approach emphasizing its anatomical basis and also to evaluate its safety and efficacy.
Settings And Design:
Retrospective study conducted at a tertiary hospital.
Materials And Methods:
Patient population included all the patients who underwent surgery for the lesions in lateral thalamus using the transylvian trans-insular approach between 2005 and 2011. A trephine craniotomy was made, centered over posterior sylvian fissure and the surgical corridor was developed through the insular cortex.
Results:
During the study period 10 patients (7 tumors and inflammatory lesions and 3 hypertensive bleeds) were treated using this approach. One peri-operative mortality was noted. In patients with lesions other than hypertensive thalamic hemorrhage, there was no postoperative worsening of neurological deficit as comparative to preoperative deficits. Total excision/evacuation of the lesion could be accomplished in all the patients.
Conclusions:
The transylvian trans-insular approach is safe, effective, anatomical procedure, and can be performed at a peripheral center without the need for navigation and intra-operative monitoring.
