A minimally invasive transsulcal approach to the paracentral inner lesion.
OBJECTIVE
Surgical options to remove lesions located deep in the sulcus at the paracentral area are limited. To minimize therapeutic morbidities, such as cortical injuries before the removal, a transsulcal approach was applied by taking the results of neuroimaging and functional mapping into consideration.


METHODS
Four patients with paracentral inner lesions including anaplastic astrocytoma, cortical dysplasia, and cavernous angioma were operated on. All lesions were located deep in the paracentral sulci. According to the outcome of MRI and functional mapping of the cortex over the lesion, the central or the postcentral sulcus was opened toward the lesion. Immediately after complete dissection of the sulcus to remove the lesion, neurological findings were evaluated in the awake state.


RESULTS
All lesions were situated beneath the hand or foot area. The transsulcal approach was successfully conducted without any neurological deficits in all cases.


CONCLUSIONS
Microsurgical techniques based on anatomic and functional information allow surgeons to reach the lesions deep in the paracentral area safely.
Mikuni
N
N
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. mikunin@kuhp.kyoto-u.ac.jp
Hashimoto
N
N
D000328:Adult; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery*; D001927:Brain Diseases / Q000473:pathology / Q000601:surgery*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D003243:Consciousness / Q000502:physiology; D019054:Evoked Potentials, Motor / Q000502:physiology; D006392:Hemangioma, Cavernous / Q000473:pathology / Q000601:surgery*; D006801:Humans; D020646:Intralaminar Thalamic Nuclei / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*