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Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to the operative room

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Abstract

The operative approach to the posterior incisural space is challenging because of its deep location, the surrounding eloquent areas, and the intimate relationship with the deep veins. Several approaches have been proposed to manage the lesions in this region: supratentorial, infratentorial and a combination of them. Brain retraction, injury to the occipital lobe and corpus callosum, and venous bleeding are the principle drawbacks of these routes. We performed anatomical dissection study using 10 embalmed human cadaver specimens injected with colored latex exploring a different route, parietal interhemispheric transfalcine transtentorial (PITT). Then we used a PITT approach on two patients with posterior incisural space (PIS) lesions. The PITT approach led to successful and safe complete removal of PIS lesions in our cases. No complications were reported. The present approach could be a valuable option in case of PIS lesions, especially those associated with downward displacement of the deep venous complex; thanks to the gravity it reduce the complications related to the occipital lobe retraction and manipulation. Moreover, cutting the superior-anterior edge of the tentorium, the sub-tentorial space could be reached.

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Authors and Affiliations

  1. Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy

    G. La Rocca, G. Sabatino, A. Rapisarda, A. Olivi & G. M. Della Pepa

  2. Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy

    G. La Rocca, G. Sabatino & E. Mazzucchi

  3. Division of Neurosurgery, Department of Neurosciences, Policlinico “G. Rodolico” University Hospital, Catania, Italy

    Roberto Altieri

  4. Department of Neuroscience “Rita Levi Montalcini,” Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy

    Roberto Altieri, D. Garbossa & F. Cofano

  5. Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia, University Hospital, Udine, Italy

    T. Ius

Authors
  1. G. La Rocca
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  2. G. Sabatino
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  3. Roberto Altieri
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  5. A. Rapisarda
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  8. F. Cofano
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  9. A. Olivi
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  10. G. M. Della Pepa
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Correspondence to Roberto Altieri.

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La Rocca, G., Sabatino, G., Altieri, R. et al. Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to the operative room. Neurosurg Rev 44, 1779–1788 (2021). https://doi.org/10.1007/s10143-020-01375-3

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  • DOI: https://doi.org/10.1007/s10143-020-01375-3

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