Transsylvian approach-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 1).
This approach, referred to as the “transinsular approach,” comprises incising the superior part of the anterior insula and exploring the plexal point of the anterior choroidal artery through the space between the dissected insula and the frontal lobe. A representative case of a patient with a large medial temporal arteriovenous malformation that was successfully extirpated by this approach is reported. The advantages of this approach and the functional results of partial incision of the insula are discussed 2).