Contralateral anterior interhemispheric-transcallosal-transrostral approach to the subcallosal region: a novel surgical technique

Abstract

OBJECTIVE The authors report a novel surgical route from a superior anatomical aspect-the contralateral anterior interhemispheric-transcallosal-transrostral approach-to a lesion located in the subcallosal region. The neurosurgical approach to the subcallosal region is challenging due to its deep location and close relationship with important vascular structures. Anterior and inferior routes to the subcallosal region have been described but risk damaging the branches of the anterior cerebral artery. METHODS Three formalin-fixed and silicone-injected adult cadaveric heads were studied to demonstrate the relationships between the transventricular surgical approach and the subcallosal region. The surgical, clinical, and radiological history of a 39-year-old man with a subcallosal cavernous malformation was retrospectively used to document the neurological examination and radiographic parameters of such a case. RESULTS The contralateral anterior interhemispheric-transcallosal-transrostral approach provides access to the subcallosal area that also includes the inferior portion of the pericallosal cistern, lamina terminalis cistern, the paraterminal and paraolfactory gyri, and the anterior surface of the optic chiasm. The approach avoids the neurocritical perforating branches of the anterior communicating artery. CONCLUSIONS The contralateral anterior interhemispheric-transcallosal-transrostral approach may be an alternative route to subcallosal area lesions, with less risk to the branches of the anterior cerebral artery, particularly the anterior communicating artery perforators.

The interhemispheric fissure—surgical outcome of interhemispheric approaches

“…Our series showed that the IHA is a technically and comparably safe operative technique. Despite new, but complicated and technically challenging approaches [9,[12][13][14]73], we could achieve complete resection (Simpson grades I + II and GTR) in 83.8% of our cases (exemplary cases 1-2) with standardized IHAs.…”

“…The aim of this manuscript is to share our experience with a large series of different IHAs in patients with extra-axial oncologic pathologies at a tertiary neurosurgical university center. With the rise of new but complicated, technically challenging, poorly tested, and therefore potentially harmful approaches [9,[12][13][14]73], this study aims to highlight the sufficiency of standardized IHAs and thus the reduction of perioperative morbidity.…”

What's your name again? A review of the superior longitudinal and arcuate fasciculus evolving nomenclature

“…There is an ongoing discussion regarding the dorsal‐most component, SLF‐I. Five publications proposed that direct frontoparietal fibers adjacent to the cingulum in the medial aspect be labeled SLF‐I (Chaddad‐Neto et al, 2018; Güngör et al, 2017; Komaitis et al, 2020; Monroy‐Sosa et al, 2019; Yagmurlu et al, 2016). Nevertheless, as those fibers are located in the medial aspect of the cerebral hemisphere (and medial to the corona radiata, in contrast to all other components of the SLF/AF), there is still a debate about the appropriateness of this nomenclature (Maldonado et al, 2012, 2020; Mandonnet et al, 2018; Wang et al, 2016).…”

How I do it: surgical resection of a subcallosal gyrus cavernous malformation by a contralateral anterior interhemispheric approach

“…3). Several approaches can be considered, each having their benefits and risks [1,2]. In this case, we preferred the contralateral anterior interhemispheric approach due to its straightforward surgical trajectory (Fig.…”

“…In this case, we preferred the contralateral anterior interhemispheric approach due to its straightforward surgical trajectory (Fig. 3) [1,5]. The patient was placed in the supine position, with the upper body elevated by 30 degrees to facilitate venous drainage.…”