title: The contralateral transfalcine transprecuneus approach to the atrium of the lateral ventricle: operative technique and surgical results.
abstract: BACKGROUND
  Surgical approaches to the atrium of the lateral ventricle remain a challenging neurosurgical issue because of the eloquent nature of the surrounding anatomy.
  
  
  OBJECTIVE
  To report our operative techniques and preliminary surgical results with the contralateral transfalcine transprecuneus approach.
  
  
  METHODS
  A retrospective data review was performed of patients undergoing a contralateral transfalcine transprecuneus approach for the resection of lesions in the atrium of the lateral ventricle. Patients were positioned in the prone position with a 30° elevation, and a 15° rotation was used. After a contralateral parasagittal parieto-occipital craniotomy and falx incision, the corticotomy in the contralateral precuneus gyrus created a corridor to the tumor. An endoscope was used to assist with the surgery.
  
  
  RESULTS
  Headache was the primary preoperative symptom, which improved in all patients after surgery. After treatment, symptoms were improved in all 3 patients with hemiparesis and in 3 of 6 patients with preexisting visual deficits; symptoms were unchanged in the other 3 patients with visual deficits during the 13- to 38-month follow-up. Nine lesions were totally removed, and 1 metastatic breast cancer lesion was subtotally removed; all patients had good neurological outcomes and no operative mortality.
  
  
  CONCLUSIONS
  The contralateral transfalcine transprecuneus approach is appropriate for most lesions in the atrium of the lateral ventricle. It provides a wider surgical angle (especially for the lateral extension) and reduces the risk of disturbance of the optic radiation compared with the conventional approaches. The use of magnetic resonance venography-magnetic resonance imaging neuronavigation makes the procedure much easier and more accurate, and the neuroendoscope adds to the visualization of the microscope and can reduce surgical complications.
authors.affiliation: ‡Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China; §Digital Medical Research Center, Fudan University, Shanghai, China; ¶Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China; #Department of Neurosurgery, Yinzhou Hospital, Medical School of Ningbo University, ZheJiang, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Xie
authors.forename: Chongjing
authors.initials: C
authors.lastname: Sun
authors.forename: Xiaobiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Jianping
authors.initials: J
authors.lastname: Zhang
authors.forename: Ye
authors.initials: Y
authors.lastname: Gu
authors.forename: Wensheng
authors.initials: W
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D020547:Lateral Ventricles / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies