Summary
The combined stereotactic-microsurgical approach has been used mainly to allow the removal of small subcortical lesions, determining their location and the route to be followed. In our experience, this approach has been most useful in 5 cases of small paraventricular AVMs and another 6 small deep-seated tumoural lesions.
Since the availability of MRI, we have systematically applied Yasargil’s proposal to perform dissection of the cisterns or sulci to reach a lesion with minimal or no injury to normal neuroanatomy. Assisted by Computer Aided Design software, we can superimpose the MR images with those provided by conventional or digital angiography (mainly the venous phase). MRI allows us to select a route or pathway through a sulcus, and angiography helps us in locating it on the brain surface.
We have applied this technique systematically during the past year, and can report 20 cases (1 AVM, 12 tumoural lesions, 1 abscess and 6 haematomas). This trans-fissural or trans-sulcal approach has allowed us resection with minimal surgical damage, after a prompt and precise location.
We think that both methods are not mutually exclusive, although the trans-sulcal approach is more adequate because of less discomfort for the patient, the smaller cerebral parenchyma injury and greater anatomofunctional information for the surgeon.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Guiot G, Rougerie J, Sachs M, et al (1960) Reperage stereotaxique de malformations vasculaires profondes intra- cerebrales. Sem Hop Paris 36:1134–1143
Garcia Sola R, Cabezudo J, Areitio E, Bravo G (1980) Combined approach (stereotactic-microsurgical) to a paraventricular arteriovenous malformation. Acta Neurochir (Wien) [Suppl] 30:413–416
Riecher T, Mundinger F (1964) Combined stereotactic operation for treatment of deep-seated angiomas and aneurysms. J Neurosurg 21:358–363
Yasargil M G, Cravens G F, Roth P (1988) Surgical approaches to “inaccessible” brain tumours. Clin Neurosurg 34:42–110
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1991 Springer-Verlag/Wien
About this paper
Cite this paper
Sola, R.G., Pulido, P., Kusak, E. (1991). Trans-Fissural or Trans-Sulcal Approach Versus Combined Stereotactic-Microsurgical Approach. In: Hitchcock, E.R., Broggi, G., Burzaco, J., Martin-Rodriguez, J., Meyerson, B.A., Tóth, S. (eds) Advances in Stereotactic and Functional Neurosurgery 9. Acta Neurochirurgica Supplementum, vol 52. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9160-6_7
Download citation
DOI: https://doi.org/10.1007/978-3-7091-9160-6_7
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-9162-0
Online ISBN: 978-3-7091-9160-6
eBook Packages: Springer Book Archive