title: Interhemispheric transfalcine approach and awake cortical mapping for resection of peri-atrial gliomas associated with the central lobule.
abstract: Medial posterior frontal and parietal gliomas extending to the peri-atrial region are difficult to reach surgically because of the working angle required to expose the lateral aspect of the tumor and the proximity of the tumor to the sensorimotor lobule; retraction of the sensorimotor cortex may lead to morbidity. The interhemispheric transfalcine approach is favorable and safe for resection of medial hemispheric tumors adjacent to the falx cerebri, but the literature on this approach is scarce. Awake cortical mapping using this operative route for tumors associated with the sensorimotor cortex has not been previously reported to our knowledge. We present the first case of a right medial posterior frontoparietal oligoastrocytoma that was resected through the interhemispheric transfalcine approach using awake cortical and subcortical mapping. Through a contralateral frontoparietal craniotomy, we excised a section of the falx and exposed the contralateral medial hemisphere. Cortical stimulation allowed localization of the supplementary motor cortex, and suprathreshold stimulation mapping excluded the primary motor cortex corresponding to the leg area. Gross total tumor resection was accomplished without any intraoperative or postoperative deficits. Awake cortical mapping using the contralateral transfalcine approach allows a "cross-court" operative route to map functional cortices and resect peri-atrial low-grade gliomas. This technique can minimize the otherwise necessary retraction on the ipsilateral hemisphere through an ipsilateral craniotomy.
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, 355 W. 16th Street, Suite 5100, Indianapolis, IN 46202, USA.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Malekpour
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, 355 W. 16th Street, Suite 5100, Indianapolis, IN 46202, USA. Electronic address: acohenmd@gmail.com.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology* / Q000601:surgery*; D003399:Craniotomy; D004558:Electric Stimulation; D005625:Frontal Lobe / Q000473:pathology; D007839:Functional Laterality; D005910:Glioma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010296:Parietal Lobe / Q000473:pathology / Q000601:surgery; D066191:Sensorimotor Cortex / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014851:Wakefulness
keywords: Awake brain mapping; Central lobule; Glioma; Interhemispheric approach; Peri-atrial region