Anatomical and surgical technical aspects of intraparietal sulcus approach for posterolateral thalamic glioma:...

Resection of thalamic tumors remains a challenge. This study aims to describe the anatomical and technical aspects of the intraparietal sulcus (IPS) approach for resecting a posterolateral thalamic glioma.

The authors reviewed the literature related to the white matter tracts and thalamic anatomy in order to describe the pivotal anatomy and technical aspects of the IPS approach. Twenty human cadaveric cerebral hemispheres were dissected. The authors correlated the findings with an illustrative case of a thalamic glioma that underwent resection. The IPS approach to the atrium was successfully performed in all hemispheres. Surface anatomy and underlying white matter tracts were identified. Fiber dissection revealed the tracts most at risk during transsulcal access, allowing analysis of the least disruptive surgical corridor. Among the options, a modified intraparietal trajectory minimized fiber transgression. Thalamic anatomy was studied in detail, focusing on technical considerations for glioma resection. In the illustrative clinical case, a posterolateral thalamic glioma was completely resected using the selected approach.

A transsulcal approach via IPS is a valid option for the resection of thalamic tumors requiring a posterosuperior and lateral view. Considering the deep white matter, the safest site to perform the approach is the posterior third of the IPS. https://thejns.org/doi/10.3171/CASE25545.