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Interhemispheric Craniotomy

Last Updated: September 27, 2018

Interhemispheric Dissection for Reaching the Ventricular System

General Considerations

The anterior or 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.

This craniotomy is situated around the coronal suture (when using a frontal interhemispheric route) or behind the central lobule (when using the superior parietal interhemispheric route) to protect the sensorimotor cortices and dominant numerous parasagittal veins, which are typically 3-4 cm posterior to the coronal suture.

Sacrifice of the large parasagittal bridging veins may lead to venous infraction and hemiparesis. Fixed retractors must be avoided through t...