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Peri-atrial GBM: Transfalcine Approach

January 18, 2016


This is another video advocating the use of the Transfalcine posterior interhemispheric approach for resection of Peri-Atrial High-Grade Gliomas. This is a 52 year-old male who presented with a partial right-sided hemianopsia an MRI evaluation harbored a relatively heterogeneously enhancing mass in the area of the inferior peri atrium extending toward the tentorium. You can see the location of a mass in the sagittal plane. Traditional approaches to this tumor include the lateral trash quarter core routes that can further affect the visual function of the patient also potentially a subtemporal approach maybe utilized, however reaching the superior portal of the tumor would demand significant amount retraction on the temporal lobe. which can place the speech areas as well as the vein of lobby at risk. To protect the residual visual function in this patient, I attempted the posterior interhemispheric transfalcine in approach, understanding that it will be a very long reach. And I have to obviously reach the tentorium in the transfalcine manner to be able to accomplish a growths resection. Let's go ahead and review my operative findings. The right or the unaffected hemisphere was placed down or in the dependent position. A lumbar drain was installed. Fallen composition of incision, a generous craniotomy was completed. The superior sagittal sinus was exposed. Part of the Douro over the contralateral hemisphere was also identified. The Fox was incised in a T-shaped fashion. You can see the junction of the Fox and the tentorium. Obviously the incision should protect the stray sinus and the associated veins. Next the inferior limb of the T-shaped incision extended to the level of the splenium small quarter economy within the precuneus. A load exposure of the tumor. standard microsurgical techniques, debarked and remove the tumor until the atrium was encountered. Here's the cystic wall, of the tumor that is being removed. Again, the tentorium was exposed assuring that the inferior pole, the tumor has been reached. Continuation on my de-section allowed remove the tumor within the operative blind spot. Here's the final operative corridor. Again, demonstrating the false in incisions, that poster in term is very transfalcine precuneus approach with minimal amount of brain transgressions, postoperative MRI demonstrated reason resection of the tumor without any complicating features. And this patient's visual function remained stable post operatively. Thank you.

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