Ipsilateral tumor-side-down approach to mesial parietal and occipital gliomas: patient series.

Background: Patient positioning is important for optimizing the window for tumor resection while minimizing complications. Mesial posterior parietal and occipital gliomas pose unique challenges due to their relationship with optic radiations, visual cortex, and cerebral sinuses. For these lesions, the authors propose placing the patient in the lateral decubitus position with the tumor side down to take advantage of gravity and minimize the need for retraction. They describe the unique surgical corridor this approach enables.

Observations: The authors identified 6 glioma patients who underwent resection of mesial parieto-occipital tumors through an ipsilateral tumor-side-down approach. Gravity-assisted retraction of the ipsilateral occipital lobe creates a safe corridor into the mesial parieto-occipital lobe for tumor resection. Gross-total resection was achieved in 5 patients. Three patients had stable visual field assessments, and 3 had worsened visual deficits postoperatively. There were no additional surgical complications in any patient.

Lessons: The ipsilateral tumor-side-down approach to mesial parieto-occipital gliomas is an effective technique for tumor resection, allowing for gravity-assisted retraction while minimizing resection of adjacent normal brain tissue to gain access to the lesion. While the goal for glioma surgery is safe maximal resection, the risk of a new or worsening visual field deficit, although minimized with this approach, may still occur. https://thejns.org/doi/10.3171/CASE25305.