Tumours of the callosal area: problems and surgical strategies

Tumours of the callosal area are quite common. However, those primarily located in this region which remain confined within the corpus callosum area not frequent. The introduction of intraoperative location devices, coupled with preoperative MR, CT and angiography, has further enhanced the operability of lesions of the deep area around the callosal body. On the basis of their site of origin, three groups of tumours can be identified: tumours originating from the corpus callosum (defined as properly callosal); tumours secondarily invading the corpus callosum; tumours affecting the corpus callosum because of their surgical approach. Various routes have been developed to reach the callosal area, the site and direction of growth of the tumour providing indications for the preferred approach. The commonest routes are the following: interhemispheric approach; transcerebral approach; transcallosal approach; the transcallosal approach to the ventricles offers a valuable corridor in the management of intraventricular tumours. It provides a rapid and safe access, without the attendant epilepsy that often follows the transcortical approach. The neuro-psychological effect of callosotomy are minimal and not affecting the daily activities of patients. Thus it is possible to reach remote regions through a narrow entry with very low neuro-psychological impact.