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An Eyebrow, Supracarotid Triangle Approach for Lesions at the Ventral Thalamopeduncular Junction: A Technical Report
Robert G Briggs1, Andrew K Conner2, Arpan R Chakraborty2
1Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
Background:
Lesions arising at the ventral thalamopeduncular junction are difficult to resect. In addition to being relatively inaccessible, these lesions are located in one of the most sensitive areas of the brain. A critical question is whether new approaches could be developed to allow surgeons to adequately resect these lesions with reasonable outcomes. In the present report, we describe our approach to resect lesions in this region of the brain using an eyebrow craniotomy approach with a trajectory through the supracarotid triangle.
Methods:
Through retrospective data collection, we present a small series of patients who had undergone an eyebrow, supracarotid triangle approach to resect lesions located at the thalamopeduncular junction. We describe our surgical technique and report patient outcomes using this approach.
Results:
Three patients had undergone an eyebrow, supracarotid approach for resection of a lesion arising at the ventral thalamopeduncular junction. Two patients had presented with a cavernoma and one with a pilocytic astrocytoma. Complete resection of all 3 lesions was achieved during surgery without any intraoperative complications. No patient developed permanent contralateral weakness despite entering the peduncle during surgery. One patient developed permanent paresthesia in his left hand.
Conclusions:
Lesions arising at the ventral thalamopeduncular junction can be adequately resected with reasonable outcomes using an eyebrow, supracarotid triangle approach. This operative technique establishes another potential operative corridor by which neurosurgeons can resect lesions arising within this relatively inaccessible part of the brain.
Insights
Neurosurgeons can effectively resect difficult ventral thalamopeduncular junction lesions using an eyebrow craniotomy and supracarotid triangle approach. This technique offers a viable new corridor for accessing these sensitive brain areas with good patient outcomes.
Area of Science:
- Neurosurgery
- Surgical Oncology
- Neuroanatomy
Background:
- Ventral thalamopeduncular junction lesions present significant surgical challenges due to their location and inaccessibility.
- Developing novel surgical approaches is crucial for achieving adequate resection and favorable outcomes for these complex lesions.
Purpose of the Study:
- To describe and evaluate the efficacy of an eyebrow craniotomy with a supracarotid triangle trajectory for resecting ventral thalamopeduncular junction lesions.
Main Methods:
- Retrospective analysis of a small patient series undergoing the eyebrow, supracarotid triangle approach.
- Detailed description of the surgical technique employed for lesion resection.
Main Results:
- Complete resection of three ventral thalamopeduncular junction lesions (two cavernomas, one pilocytic astrocytoma) was achieved.
- No intraoperative complications or permanent contralateral weakness were observed; one patient experienced transient paresthesia.
Conclusions:
- The eyebrow, supracarotid triangle approach provides a safe and effective corridor for resecting lesions at the ventral thalamopeduncular junction.
- This technique expands the surgical options for neurosurgeons treating tumors in this challenging brain region.
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