The Case Series of Contralateral Interhemispheric Transfalcine Approach to Medial Parietooccipital Pathologies:...

The medial parietooccipital and peritrigonal areas present challenges for neurosurgical procedures. Adjacency to the eloquent cortex-postcentral gyrus and cuneus, as well as crucial white matter tracts, such as optic radiation-makes the surgical approaches difficult. This study aims to describe the surgical technique and outcomes of treating lesions using the contralateral approach.

This study is a retrospective analysis of 19 surgical cases treated in the Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, in Łódź between April 2021 and May 2024.

Nineteen cases were treated with the contralateral posterior interhemispheric transfalcine transprecuneus approach. Six cases were vascular (all arteriovenous malformation) and 13 tumors (5 glioblastomas, 4 meningiomas, 4 metastasis, and 1 pilocytic astrocytoma). Twelve of them were in precuneus, 3 in the peritrigonal part of lateral ventricle, 2 in falx, and 2 in pulvinar. The mean surgery time was 4 hours 15 minutes ± 2 hours 21 minutes. The superior sagittal sinus was injured and managed using suture and hemostatic material in 2 cases. In 2 cases, a small anastomotic vein was sacrificed, and in none of cases, a venous infarction related to anastomotic veins was observed. A new neurologic deficit was present in 8 cases post-surgery improving after a few days. The mean hospitalization time was 11 ± 8.7 days.

The contralateral interhemispheric transfalcine approach is a valuable surgical technique for managing medial parietooccipital and peritrigonal lesions.