Vols. Videos

Contralateral Interhemispheric Transfalcine Transprecuneus Approach

Last Updated: September 27, 2018

Transfalcine Approach for an Atrial/Splenial AVM

General Considerations

The posterior interhemispheric craniotomy provides access to deep midline parafalcine and paraventricular spaces through the natural interhemispheric fissure. Although working in this natural plane has numerous benefits, such as a minimal need for brain retraction and transgression, the working corridor can be deep and narrow, making surgery in this region technically challenging.

The reach to expose the peritrigonal/atrial territories poses special challenges. The highly functional overlying cortices and white matter tracts such as the optic radiations lateral to the ventricle, postcentral gyrus laterally and more superficially, and the thalamus anteroinferiorly, constrain the surgical corridors to the atrium. Standard interhemispheric or transcortical approaches involve significant retraction and resection of the normal parenchyma.

Our colleagues have described t...