Using of transsulcal microsurgical approach in surgical treatment of intracerebral lesions - literature review

Abstract

The surgical resection of intracerebral lesions, and particularly those in the dominant hemisphere, is often a challenge. Standard approaches require significant brain retraction or resection of normal neural tissue. However, the type of surgical approach affects on the postoperative recovery and complications. The introduction of the microsurgery and computer-led stereotactic laser resection, neuronavigation, brain mapping -all these methods which allows a complete resection and sparing of the surrounding normal neural tissue, improves the results and the pursuit of atraumatic neurosurgical operations. Our goal was to make a literature review on application of trans-sulcal microsurgical approach by other authors, since its introduction in the microneurosurgery practice by Prof. G.Yasargil in 1986. It is a minimally invasive technique that is relatively simple and provides additional accuracy and safety of the surgical procedure. It ensures less traumatic surgical interventions and preserves as much as possible the physiological and anatomical structures of the cerebrum. Key words: trans-sulcal microsurgical approach, minimally invasive brain surgeryEver since its introduction in 1965 by Prof. G. Yasargil, microneurosurgery goes deeply into all sections of neurosurgical practice and gives the opportunity many new surgical methods to be introduced, while many of the old ones to be improved and be carried out with greater certainty and atraumacity. On the other hand, the entry into the daily practice of less invasive and aggressive but more accurate diagnostics (CT, MRI, PET), which can accurately depict pathoanatomical and pathophysiological characteristics of the lesion, facilitates the diagnosis of small asymptomatic lesions located in the deep parts of the brain hemispheres. That is how appears the need of using new, improved surgical techniques with which these lesions can be achieved with minimal damage to the cortex. Trans-sulcal microsurgical approach is based on the idea that the less is the damage to the cerebral cortex and white matter, the less damage is caused to the patient by the surgeon (1). In 1986 G.Yasargil indicates that there are no "silent areas" in the brain. All areas are eloquent _____________________________ *Correspondence to: St. Valkanov, Clinic of Neurosurgery, University Hospital, Stara Zagora, Bulgaria, nhk_stz@yahoo.com and each has its own unique function. They are all intricately interwoven and integrated into a dynamic unity. Here he brings the idea of respect for a basic surgical principle those natural anatomic routes (cisternal, sulcal, fissural, ventricular) can be used to reach deep localized tumors and perform a pure "tumorectomy "thereby avoiding compression or resection of normal neural tissue (2). It also gives a schematic representation of a sulcal and fissure structures available in front of and behind biauricular line (Figures 1 and 2).In 1989, Harkey HL et al presents an anatomical study of cerebral sulci on a cadaver brains which were dissected using o...