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Related Experiment Video

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Contralateral Transfalcine Approach for Recurrent Glioblastoma: A Technical Note on Multimodal Planning,

Giuseppe Emmanuele Umana1, Francesco Corrivetti2, Salvatore Marrone3

  • 1Department of Neurosurgery, Cannizzaro Hospital, Trauma and Gamma Knife Center, Catania, Italy; Department of Medicine and Surgery, University Kore of Enna, Enna, Italy.

World Neurosurgery
|October 19, 2025
PubMed
Summary

A contralateral transfalcine approach offers a safe and effective surgical option for recurrent glioblastoma (GBM) in eloquent brain areas. This technique, using advanced navigation, facilitates maximal tumor resection while preserving neurological function.

Keywords:
5-ALADTI tractographyGlioblastomaNeuronavigationTMS mappingTransfalcine approach

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Area of Science:

  • Neurosurgery
  • Oncology
  • Brain Tumor Research

Background:

  • Resection of recurrent glioblastoma (GBM) in eloquent brain regions presents significant surgical challenges.
  • Altered anatomy, gliosis, and the risk of neurological deficits complicate these procedures.
  • Alternative surgical corridors and multimodal guidance are crucial for safe and maximal resection.

Purpose of the Study:

  • To describe the technical nuances of a contralateral transfalcine approach for recurrent GBM.
  • To evaluate the safety and efficacy of this approach in a patient with a left fronto-mesial GBM.
  • To highlight the role of advanced preoperative planning and intraoperative guidance.

Main Methods:

  • A contralateral transfalcine approach was planned to avoid scarred tissue and preserve motor function.
  • Preoperative planning involved navigated transcranial magnetic stimulation, PET-MRI fusion, MRS, and DTI tractography.
  • Intraoperative neuronavigation, neurophysiological monitoring, and 5-ALA fluorescence guided the resection.

Main Results:

  • Gross total resection of the recurrent GBM was achieved via the transfalcine approach.
  • Postoperative MRI confirmed complete tumor removal, and the patient remained neurologically intact.
  • Histology confirmed GBM; no recurrence was observed at 1-year follow-up.

Conclusions:

  • The contralateral transfalcine approach, supported by multimodal planning, optimizes surgical outcomes for recurrent GBM near eloquent areas.
  • This technique minimizes cortical transgression and facilitates en bloc resection.
  • It integrates effectively into multidisciplinary treatment strategies for glioblastoma.