The missing falx: a potential surgical pitfall during interhemispheric transcallosal approach.

Area of Science:

• Neurosurgery
• Developmental Neuroscience
• Pediatric Neurology

Background:

• Interhemispheric dissection along the falx cerebri is a standard surgical approach for lateral ventricular tumors.
• The falx cerebri serves as a critical midline landmark for neurosurgeons.
• Unrecognized absence of the falx can lead to significant surgical complications.

Observation:

• A child with tuberous sclerosis presented with refractory epilepsy and a lateral ventricular tumor.
• The tumor was surgically excised using an interhemispheric trans-callosal approach.
• Anterior absence of the midline falx cerebri was noted, complicating midline identification.

Findings:

• The study highlights the surgical implications of an absent falx cerebri, a structure crucial for navigation in the interhemispheric approach.
• It underscores the importance of pre-operative awareness regarding potential anatomical variations like falx absence.
• The case demonstrates challenges in identifying the midline during neurosurgery when this landmark is deficient.

Implications:

• Recognizing and anticipating falx cerebri absence is crucial for surgical planning and patient safety in neurosurgery.
• Understanding the embryology of falcine development can inform surgical strategies for midline brain lesions.
• This case emphasizes the need for meticulous anatomical assessment to prevent surgical complications related to landmark anomalies.