OBJECTIVE The authors report a novel surgical route from a superior anatomical aspect—the contralateral anterior interhemispheric-transcallosal-transrostral approach—to a lesion located in the subcallosal region. The neurosurgical approach to the subcallosal region is challenging due to its deep location and close relationship with important vascular structures. Anterior and inferior routes to the subcallosal region have been described but risk damaging the branches of the anterior cerebral artery. METHODS Three formalin-fixed and silicone-injected adult cadaveric heads were studied to demonstrate the relationships between the transventricular surgical approach and the subcallosal region. The surgical, clinical, and radiological history of a 39-year-old man with a subcallosal cavernous malformation was retrospectively used to document the neurological examination and radiographic parameters of such a case. RESULTS The contralateral anterior interhemispheric-transcallosal-transrostral approach provides access to the subcallosal area that also includes the inferior portion of the pericallosal cistern, lamina terminalis cistern, the paraterminal and paraolfactory gyri, and the anterior surface of the optic chiasm. The approach avoids the neurocritical perforating branches of the anterior communicating artery. CONCLUSIONS The contralateral anterior interhemispheric-transcallosal-transrostral approach may be an alternative route to subcallosal area lesions, with less risk to the branches of the anterior cerebral artery, particularly the anterior communicating artery perforators.
Bibliographical noteFunding Information:
This study was supported in part by funds from the Newsome Chair in Neurosurgery Research held by Dr. Preul, the Barrow Women’s Board, and the Barrow Neurological Foundation. We thank the Neuroscience Publications staff at Barrow Neurological Institute for assistance with manuscript preparation.
© AANS 2018.
Copyright 2019 Elsevier B.V., All rights reserved.
- Cavernous malformation
- Corpus callosum
- Interhemispheric transcallosal
- Subcallosal region
- Surgical approach
- Surgical technique