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An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report

BACKGROUND: The surgical management of lesions located in the trigone of the lateral ventricle remains a neurosurgical challenge. Previously described approaches to the atrium include the transtemporal, parietal transcortical, parietal trans intraparietal sulcus, occipital transcingulate, posterior...

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Autores principales: Barrenechea, Ignacio J., Márquez, Luis, Miralles, Sabrina, Baldoncini, Matias, Peralta, Silvina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749951/
https://www.ncbi.nlm.nih.gov/pubmed/33365170
http://dx.doi.org/10.25259/SNI_608_2020
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author Barrenechea, Ignacio J.
Márquez, Luis
Miralles, Sabrina
Baldoncini, Matias
Peralta, Silvina
author_facet Barrenechea, Ignacio J.
Márquez, Luis
Miralles, Sabrina
Baldoncini, Matias
Peralta, Silvina
author_sort Barrenechea, Ignacio J.
collection PubMed
description BACKGROUND: The surgical management of lesions located in the trigone of the lateral ventricle remains a neurosurgical challenge. Previously described approaches to the atrium include the transtemporal, parietal transcortical, parietal trans intraparietal sulcus, occipital transcingulate, posterior transcallosal, and transfalcine transprecuneus. However, reaching this area specifically through the cingulate cortex below the subparietal sulcus has not been described thus far. CASE DESCRIPTION: We present here the removal of a left atrial meningioma through a right parietal “contralateral interhemispheric transfalcine transcingular infra-precuneus” approach and compare it with previously described midline approaches to the atrium. To accomplish this, a right parietal craniotomy was performed. After the left subprecuneus cingulate cortex was exposed through a window in the falx, a limited corticotomy was performed, which allowed the tumor to be reached after deepening the bipolar dissection by 8 mm. Postoperative magnetic resonance imaging showed complete resection of the lesion sparing the corpus callosum, forceps major, and sagittal stratum. Although this approach disrupts the posterior cingulate fasciculus, no deficits have been described so far after unilaterally disrupting the posterior cingulate cortex or the posterior part of the cingulate fasciculus. In fact, a thorough postoperative cognitive examination did not show any deficits. CONCLUSION: The “contralateral interhemispheric transfalcine transcingular infra-precuneus” approach combines the advantages of several previously described approaches. Since it conserves the major white matter tracts that surround the atrium and has a shorter attack angle than the contralateral transfalcine transprecuneus approach, we believe that it could be a potentially new alternative path to reach atrial lesions.
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spelling pubmed-77499512020-12-22 An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report Barrenechea, Ignacio J. Márquez, Luis Miralles, Sabrina Baldoncini, Matias Peralta, Silvina Surg Neurol Int Case Report BACKGROUND: The surgical management of lesions located in the trigone of the lateral ventricle remains a neurosurgical challenge. Previously described approaches to the atrium include the transtemporal, parietal transcortical, parietal trans intraparietal sulcus, occipital transcingulate, posterior transcallosal, and transfalcine transprecuneus. However, reaching this area specifically through the cingulate cortex below the subparietal sulcus has not been described thus far. CASE DESCRIPTION: We present here the removal of a left atrial meningioma through a right parietal “contralateral interhemispheric transfalcine transcingular infra-precuneus” approach and compare it with previously described midline approaches to the atrium. To accomplish this, a right parietal craniotomy was performed. After the left subprecuneus cingulate cortex was exposed through a window in the falx, a limited corticotomy was performed, which allowed the tumor to be reached after deepening the bipolar dissection by 8 mm. Postoperative magnetic resonance imaging showed complete resection of the lesion sparing the corpus callosum, forceps major, and sagittal stratum. Although this approach disrupts the posterior cingulate fasciculus, no deficits have been described so far after unilaterally disrupting the posterior cingulate cortex or the posterior part of the cingulate fasciculus. In fact, a thorough postoperative cognitive examination did not show any deficits. CONCLUSION: The “contralateral interhemispheric transfalcine transcingular infra-precuneus” approach combines the advantages of several previously described approaches. Since it conserves the major white matter tracts that surround the atrium and has a shorter attack angle than the contralateral transfalcine transprecuneus approach, we believe that it could be a potentially new alternative path to reach atrial lesions. Scientific Scholar 2020-11-25 /pmc/articles/PMC7749951/ /pubmed/33365170 http://dx.doi.org/10.25259/SNI_608_2020 Text en Copyright: © 2020 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Barrenechea, Ignacio J.
Márquez, Luis
Miralles, Sabrina
Baldoncini, Matias
Peralta, Silvina
An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report
title An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report
title_full An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report
title_fullStr An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report
title_full_unstemmed An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report
title_short An alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: A case report
title_sort alternative path to atrial lesions through a contralateral interhemispheric transfalcine transcingular infra-precuneus approach: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749951/
https://www.ncbi.nlm.nih.gov/pubmed/33365170
http://dx.doi.org/10.25259/SNI_608_2020
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