Integrated Multimaneuver Dissection Technique of the Sylvian Fissure: Operative Nuances

Several intracranial pathologies require opening the Sylvian fissure to be approached, and they are traditionally accessed through the frontal side of the superficial Sylvian veins. The integrated multimaneuver dissecting technique (IMMDT) interchanges the steps with the veins still secured for safe dissection, but the Sylvian fissure is approached from the optimal, safe side with integrated techniques.

To determine whether the 1-way dissection of the Sylvian fissure converts to the more favorable and flexible IMMDT.

The IMMDT for the Sylvian fissure was used on all our patients. The selected subjects (n = 3) had different pathologies, radiological data, and pre- and postoperative clinical data. These subjects were reviewed retrospectively.

The 3 patients presented with different pathologies necessitating opening the Sylvian fissure. The Sylvian fissure was not simple in all cases. In all 3 cases, the Sylvian veins and their branches were saved, as confirmed by postoperative images. The patients all had good neurological outcomes, with either stable or improved modified Rankin Scale at the last follow-up.

This study demonstrated that the IMMDT is a safe alternative to other ways of opening a Sylvian fissure composed of complex venous anatomy. The IMMDT aligned the fissure in multiple directions to the exposed trajectory, optimized its approach for a flexible, safe dissection, allowed the instruments to work into the Sylvian fissure, and facilitated exposure of the deep part of the fissure for the final dissection, all without scarifying any structure.