A Contralateral, Trans-falcine Approach to the Mesial Fronto-Parietal Region and Cingulate Gyrus: A Cadaveric Feasibility Study.

BACKGROUND: Neurosurgery for lesions located the mesial fronto-parietal region and cingulate gyrus may need significant brain retraction, which may cause neural injury. Therefore, the goal of this anatomical study was to evaluate a contralateral trasns-falcine approach to these regions.

METHODS: Eight adult cadaver heads were used in this study. An 8 x 8 cm craniotomy was performed, and bilateral longitudinal incisions were made into the dura mater adjacent to the superior sagittal sinus. Measurements were then taken to see how much retraction was necessary for an ipsilateral approach to the mesial fronto-parietal region down to the cingulate gyrus and compared to measurements using a contralateral trans-falcine to this same region.

RESULTS: Ipsilateral approaches required 1.5-3 cm of lateral retraction (40 to 50 degrees) from the midline whereas contralateral trans-falcine approaches required 0.5-1 cm of lateral retraction (10 to 20 degrees).

CONCLUSION: In comparison to the traditional ipsilateral interhemispheric approach to lesions of the mesial fronto-parietal region and cingulate gyrus, the contralateral transfalcine approach was found to necessitate less hemispheric retraction and provided a better working angle. Clinical validation of this technique is now necessary.