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transsylvian_approach

Transsylvian approach

Insular gliomas represent a unique surgical challenge due to the complex anatomy and nearby vascular elements associated within the Sylvian fissure. For certain tumors, the transsylvian approach provides an effective technique for achieving maximal safe resection.

Transsylvian approaches shorten the surgical distance to these lesions, preserve perisylvian temporal and frontal cortex, and minimize brain transgression.

The anterior approach opened the sphenoidal and insular portions of the sylvian fissure and exposed the limen insulae and short gyri of insula, whereas the posterior approach opened the insular and opercular portions of the sylvian fissure and exposed the circular sulcus and long gyri.

see also Transtemporal transchoroidal fissure approach

The transsylvian approach 1) through a pterional craniotomy 2) 3) is particularly useful for anterior basal extrinsic lesions and for frontobasal, mesial temporal, and insular intrinsic intracranial lesions.

Transsylvian-transinsular approaches safely expose vascular pathology in or deep to the insula while preserving overlying eloquent cortex in the frontal and temporal lobes. The anterior transsylvian-transinsular approach can be differentiated from the posterior approach based on technical differences in splitting the sylvian fissure and anatomic differences in final exposure. Discriminating patient selection and careful microsurgical technique are essential 4).


A transsylvian anteromedial approach through the pyriform cortex at the level of the anterior and superior surface of the uncus enables a safe entry into the temporal horn without injury to the optic radiation fibers or the main part of the uncinate fasciculus 5).

1)
Yasargil MG, Kasdaglis K, Jain KK, et al: Anatomical observations of the subarachnoid cisterns of the brain during surgery. J Neurosurg 44:298–302, 1976
2)
Yasargil MG, Fox JL, Ray MW: The operative approach to aneurysms of the anterior communicating artery, in Krayenbül H (ed): Advances and Technical Standards in Neurosurgery. Wien: Springer-Verlag, 1975, Vol 2, pp 114–170
3)
Yasargil MG, Krisht AF, Türe U, et al: Microsurgery of insular gliomas: Part I, II, IV. Contemporary Neurosurgery 24:(11):1–8; (13):1–6; (14):1–8, 2002
4)
Potts MB, Chang EF, Young WL, Lawton MT; UCSF Brain AVM Study Project. Transsylvian-transinsular approaches to the insula and basal ganglia: operative techniques and results with vascular lesions. Neurosurgery. 2012 Apr;70(4):824-34; discussion 834. doi: 10.1227/NEU.0b013e318236760d. PubMed PMID: 21937930; PubMed Central PMCID: PMC3303997.
5)
Coppens JR, Mahaney KB, Abdulrauf SI. An anteromedial approach to the temporal horn to avoid injury to the optic radiation fibers and uncinate fasciculus: anatomical and technical note. Neurosurg Focus. 2005 Jun 15;18(6B):E3. PubMed PMID: 16048298.
transsylvian_approach.txt · Last modified: 2017/03/02 20:19 by administrador