Surgical Anatomy of Supratentorial Midline Lesions

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Figure 2. Schematic drawing showing surgical approaches to supratentorial midline lesions. 1 = anterior frontal approach; 2 = posterior frontal approach; 3a = parietooccipital approach; 3b = parietooccipital transtentorial approach. (Reprinted with permission from Yasargil MG: Microneurosurgery IVB: Microneurosurgery of CNS Tumors. Stuttgart: Georg Thieme Verlag, 1996, p 315.) It is an indisputable fact that falcine and callosal lesions, and saccular aneurysms of A2 and A3 segments are explored and removed (or occluded with clips) via an exploration in to the interhemispheric fissure. This is considered a routine approach for the majority of midline lesions. Endovascular and gamma knife surgeries have proven effective for some types of tumors and for AVMs of smaller dimensions. Computer-assisted stereotactic, endoscopic, or microsurgical procedures are certainly accurate in targeting these lesions, but transcerebral trajectories to approach a lesion surgically are accompanied by unavoidable injuries to the neopallial cortices and connective fiber systems of the white matter. Illustrative Cases A few patients with typical deep midline lesions chosen from several hundred cases treated by the senior author (M.G.Y.) at the University of Arkansas for Medical Sciences in Little Rock illustrate the effectiveness of inter hem i spheric approaches (Figs. 3-12).
Figure 3. Case 1. A-C: Preoperative MR images demonstrating a large tumor occupying the anterior and subcallosal areas of the right cingulate gyrus. D-F: Postoperative MR images obtained after removal of the tumor.
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from 0 to 7 (average, 1.1) per hemi
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DISCUSSION The fibers of the corpus
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circulation to be determined, which
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diencephalon. For this group, the t
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Arteries of the insula middle, and
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Arteries of the insula divided into
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Arteries of the insula Parasylvian
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Arteries of the insula The frontal
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Arteries of the insula FIG. 7. Phot
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Arteries of the insula 17. Penfield
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Surgical Anatomy of Supratentorial Midline Lesions

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