Tractography Guided Endoport-assisted Superior Parietal Lobe Trans-sulcus Approach for Trigone Meningioma: A...

The trigone of the lateral ventricle is surrounded by important white matter fibers, making it difficult to approach. White matter fibers, such as the superior longitudinal fasciculus, optic radiation, arcuate fasciculus, and inferior fronto-occipital fasciculus, can be clearly depicted by tractography. We propose the safest approach to a trigonal tumor of the lateral ventricle via the superior parietal lobe using tractography. Case: A 49-year-old female presented to our hospital with a chronic headache. Magnetic resonance imaging revealed a meningioma with partial hydrocephalus in the trigone of the left lateral ventricle. After total gross resection, the patient exhibited no cranial nerve, visual, sensorimotor, or language deficits. However, there was a mild acalculia right after surgery, from which the patient made an excellent recovery with no neurological deficits at 3 months after surgery. The endoport-assisted superior parietal lobe trans-sulcus approach using tractography is the safest approach to the trigonal lesion, as it protects the most important white matter fibers around the lateral ventricular trigone.