The Case Series of Contralateral Interhemispheric Transfalcine Approach to Medial Parietooccipital Pathologies: Surgical Technique and Results.

Background and objectives: The medial parietooccipital and peritrigonal areas present challenges for neurosurgical procedures. Adjacency to the eloquent cortex-postcentral gyrus and cuneus, as well as crucial white matter tracts, such as optic radiation-makes the surgical approaches difficult. This study aims to describe the surgical technique and outcomes of treating lesions using the contralateral approach.

Methods: This study is a retrospective analysis of 19 surgical cases treated in the Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, in Łódź between April 2021 and May 2024.

Results: Nineteen cases were treated with the contralateral posterior interhemispheric transfalcine transprecuneus approach. Six cases were vascular (all arteriovenous malformation) and 13 tumors (5 glioblastomas, 4 meningiomas, 4 metastasis, and 1 pilocytic astrocytoma). Twelve of them were in precuneus, 3 in the peritrigonal part of lateral ventricle, 2 in falx, and 2 in pulvinar. The mean surgery time was 4 hours 15 minutes ± 2 hours 21 minutes. The superior sagittal sinus was injured and managed using suture and hemostatic material in 2 cases. In 2 cases, a small anastomotic vein was sacrificed, and in none of cases, a venous infarction related to anastomotic veins was observed. A new neurologic deficit was present in 8 cases post-surgery improving after a few days. The mean hospitalization time was 11 ± 8.7 days.

Conclusion: The contralateral interhemispheric transfalcine approach is a valuable surgical technique for managing medial parietooccipital and peritrigonal lesions.