Contralateral Interhemispheric Transfalcine Approach for Intra-Axial Medial Occipital Lesion: 2-Dimensional Operative...

Area of Science:

• Neurosurgery
• Surgical Neurology
• Neuroanatomy

Background:

• Accessing intra-axial mesial cortical lesions presents significant surgical challenges.
• Standard transcortical approaches risk damaging critical white matter tracts like the superior longitudinal fasciculus.
• Ipsilateral interhemispheric approaches may require manipulation of fragile perilesional tissue.

Purpose of the Study:

• To evaluate the feasibility and efficacy of the contralateral interhemispheric transfalcine (CIHTF) approach for mesial intra-axial lesions.
• To demonstrate a novel surgical technique that minimizes brain retraction and parenchymal manipulation.

Main Methods:

• The CIHTF approach was utilized for a patient with a mesial occipital lobe lesion.
• Patient positioning and a lumbar drain facilitated gravity autoretraction.
• The falx cerebri was opened to access the contralateral lesion, which was removed piecemeal with fluorescence imaging.

Main Results:

• Complete resection of the intra-axial lesion was achieved.
• The patient experienced significant improvement in vision (left homonymous hemianopia).
• Postoperative imaging at 8 months showed no recurrence of the metastatic adenocarcinoma.

Conclusions:

• The CIHTF approach provides a viable and safe method for treating mesial intra-axial lesions.
• This technique offers advantages including gravity-assisted retraction and avoidance of parenchymal injury.
• The CIHTF approach facilitates access to difficult-to-reach brain tumors with favorable outcomes.