Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions

indications, technique, and outcomes

Bradley N. Bohnstedt, Charles G. Kulwin, Mitesh V. Shah, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECT: Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route.

METHODS: Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed.

RESULTS: The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5.

CONCLUSIONS: Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

Original languageEnglish (US)
Pages (from-to)1045-1054
Number of pages10
JournalJournal of Neurosurgery
Volume123
Issue number4
DOIs
StatePublished - Oct 1 2015

Fingerprint

Glasgow Outcome Scale
Arteriovenous Malformations
Meningioma
Glioma
Pathology
Brain
Neoplasms
Gray Matter
White Matter

Keywords

  • arteriovenous malformation
  • atrium
  • AVM = arteriovenous malformation
  • GOS = Glasgow Outcome Scale
  • interhemispheric approach
  • microsurgical resection
  • PITTA = posterior interhemispheric transfalcine transprecuneus approach
  • surgical approach
  • surgical technique
  • trigone
  • tumor

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions : indications, technique, and outcomes. / Bohnstedt, Bradley N.; Kulwin, Charles G.; Shah, Mitesh V.; Cohen-Gadol, Aaron.

In: Journal of Neurosurgery, Vol. 123, No. 4, 01.10.2015, p. 1045-1054.

Research output: Contribution to journalArticle

@article{eaec335e9fbe44fba1ac77a443f08120,
title = "Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes",
abstract = "OBJECT: Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route.METHODS: Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed.RESULTS: The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7{\%}) was intentionally subtotally resected, but ≥ 95{\%} resection was achieved in all others (93{\%}) and gross-total resection was accomplished in 7 (54{\%}) of 13. One patient (7{\%}) experienced a temporary approach-related complication. At last follow-up, 1 patient (7{\%}) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14{\%}) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79{\%}) manifested a GOS score of 5.CONCLUSIONS: Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.",
keywords = "arteriovenous malformation, atrium, AVM = arteriovenous malformation, GOS = Glasgow Outcome Scale, interhemispheric approach, microsurgical resection, PITTA = posterior interhemispheric transfalcine transprecuneus approach, surgical approach, surgical technique, trigone, tumor",
author = "Bohnstedt, {Bradley N.} and Kulwin, {Charles G.} and Shah, {Mitesh V.} and Aaron Cohen-Gadol",
year = "2015",
month = "10",
day = "1",
doi = "10.3171/2015.3.JNS14847",
language = "English (US)",
volume = "123",
pages = "1045--1054",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

TY - JOUR

T1 - Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions

T2 - indications, technique, and outcomes

AU - Bohnstedt, Bradley N.

AU - Kulwin, Charles G.

AU - Shah, Mitesh V.

AU - Cohen-Gadol, Aaron

PY - 2015/10/1

Y1 - 2015/10/1

N2 - OBJECT: Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route.METHODS: Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed.RESULTS: The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5.CONCLUSIONS: Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

AB - OBJECT: Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route.METHODS: Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed.RESULTS: The mean age of patients at the time of surgery was 39 years (range 11-64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5-19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5.CONCLUSIONS: Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

KW - arteriovenous malformation

KW - atrium

KW - AVM = arteriovenous malformation

KW - GOS = Glasgow Outcome Scale

KW - interhemispheric approach

KW - microsurgical resection

KW - PITTA = posterior interhemispheric transfalcine transprecuneus approach

KW - surgical approach

KW - surgical technique

KW - trigone

KW - tumor

UR - http://www.scopus.com/inward/record.url?scp=84953344751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953344751&partnerID=8YFLogxK

U2 - 10.3171/2015.3.JNS14847

DO - 10.3171/2015.3.JNS14847

M3 - Article

VL - 123

SP - 1045

EP - 1054

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 4

ER -