Peri-Atrial Glioma: Ipsilateral Approach-Pitfalls

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Let's review the pitfalls for resection of medial parietal peri-atrial gliomas, via the ipsilateral interhemispheric corridor. This is a 17 year old male, with an incidental low grade glioma, within the medial parietal peri-atrial region. Early in my career, I approached these lesions via the ipsilateral, parietal occipital interhemispheric craniotomy. However, the extent of exposure very lateral, is very limited via the ipsilateral route. Within the past six or seven years, I have used the contralateral parasagittal interhemispheric transfalcine craniotomy, to reach the lateral aspect of the tumor. This video is from early on in my career and demonstrates the pitfalls of using the ipsilateral parietal occipital craniotomy. Here is the superior sagittal sinus. Is the ipsilateral approach. Patient is located prone. Here you can see the folks, using retraction on the ipsilateral parietal lobe to remove the tumor. But again, you can see the extent of exposure more medially, reaching more laterally is very limited. Even with further retraction, I'm able to remove the tumor. I use neuronavigation, but because of brain retraction immobilization, the neuronavigation may not be very accurate in demonstrating the exact lateral border of the tumor. At this junction, the navigation indicated that the tumor is adequately removed. However, post-operative MRI demonstrated some residual tumor again, because of my operative blind spot underneath the lip of the resection cavity, which prevented my visualization of this portion of the tumor. And again, this case emphasizes the superiority of a transfalcine approach, to expose the more posterior and lateral extent of the tumor. Thank you.

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