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Pitskhelauri D.I.

Skolkovo Institute of Science and Technology

Ishkinin R.E.

Burdenko Neurosurgical Center

Bykanov A.E.

Burdenko Neurosurgical Center

Sanikidze A.Z.

Burdenko Neurosurgical Center

Buklina S.B.

Burdenko Neurosurgical Center

Abramyan A.A.

Burdenko Center of Neurosurgery

Pronin I.N.

Burdenko Neurosurgical Center

Anterior transperiinsular approach to the head of the caudate nucleus and mediobasal frontal lobe

Authors:

Pitskhelauri D.I., Ishkinin R.E., Bykanov A.E., Sanikidze A.Z., Buklina S.B., Abramyan A.A., Pronin I.N.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2021;85(6): 54‑60

DOI: 10.17116/neiro20218506154

Read: 2871 times

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Table of contents

ANTERIOR TRANSPERIINSULAR APPROACH TO THE HEAD OF THE CAUDATE NUCLEUS AND MEDIOBASAL FRONTAL LOBE
ANTERIOR TRANSPERIINSULAR APPROACH TO THE HEAD OF THE CAUDATE NUCLEUS AND MEDIOBASAL FRONTAL LOBE

To cite this article:

Pitskhelauri DI, Ishkinin RE, Bykanov AE, Sanikidze AZ, Buklina SB, Abramyan AA, Pronin IN. Anterior transperiinsular approach to the head of the caudate nucleus and mediobasal frontal lobe. Burdenko's Journal of Neurosurgery. 2021;85(6):54‑60. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20218506154

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

BACKGROUND

The head of the caudate nucleus and adjacent mediobasal frontal lobe are deeply localized and have complex anatomical and topographic relationships with surrounding functionally significant cerebral structures. These aspects determine difficult surgical treatment of pathology in this zone.

OBJECTIVE

To propose a new anterior transperiinsular approach for optimizing surgical access to the head of the caudate nucleus and mediobasal frontal lobe.

MATERIAL AND METHODS

Two patients with cavernoma of the head of the caudate nucleus and oligodendroglioma of the head of the caudate nucleus and mediobasal frontal lobe underwent resection via transsylvian anterior transperiinsular approach in 2018. In both cases, tumors were localized in dominant hemisphere. Standard MRI was performed before and after surgery. Luria’s neurological and neuropsychological examination was carried out before surgery, in 7 days after surgery and then every 3 months.

RESULTS

Surgical access was performed via stage-by-stage proximal dissection of Sylvian fissure with visualization of anterior and superior periinsular grooves. After that, periinsular groove was dissected at the base of anterior short gyrus. Then, we moved apart white matter using microinstruments and approached the area of interest. In case of this trajectory, surgical approach was performed at the level of the upper parts of inferior frontooccipital fascicle under the arcuate fascicle. Both patients underwent total resection of tumors that was confirmed by MRI. No pre- and postoperative neurological or neuropsychological abnormalities were observed.

CONCLUSION

Anterior transperiinsular approach provides minimally invasive access to the head of the caudate nucleus and mediobasal frontal lobe. It can be used on dominant hemisphere without significant risk of speech or other cognitive impairments. The advantages of this approach are minimal damage to associative pathways and small distance between periinsular groove and zone of interest. Dissection of commissural fibers of the corpus callosum is not required compared to conventional transcallosal approach.

Keywords:

transperiinsular access
head of the caudate nucleus
mediobasal frontal lobe

Authors:

Pitskhelauri D.I.

Skolkovo Institute of Science and Technology

Ishkinin R.E.

Burdenko Neurosurgical Center

Bykanov A.E.

Burdenko Neurosurgical Center

Sanikidze A.Z.

Burdenko Neurosurgical Center

Buklina S.B.

Burdenko Neurosurgical Center

Abramyan A.A.

Burdenko Center of Neurosurgery

Pronin I.N.

Burdenko Neurosurgical Center

Received:

19.10.2020

Accepted:

08.10.2021

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