Surgical approaches to tumors of the anterior gyrus cinguli.

BACKGROUND

Tumors of the gyrus cinguli are deep-seated, and may require a variety of surgical options. We focused on anterior tumors, which have specific anatomic and surgical features.

OBJECTIVE

To evaluate different approaches and indications through detailed description and a review of our experience.

METHODS

These approaches include unilateral interhemispheric or combined: bilateral interhemispheric, unilateral plus superior frontal gyrectomy, or unilateral plus frontal polectomy. The relevance of this retrospective analysis is stressed by the extremely limited literature in this regard.

RESULTS

In the past 5 years we operated on 38 patients with gliomas. We compared the following variables: location (perigenual, prerolandic), pathology (glioblastoma, other gliomas), size (<4 cm, > or =4 cm), extension (unilateral, bilateral), and approach (unilateral interhemispheric, combined). The only significant association we found was between tumor location (perigenual) and bilateral extension (P < .01). However, combined approaches were adopted only slightly more frequently in this region than in the prerolandic area, and this resulted in a lower rate of total removal (33% vs 76%, P < .01). Gross total removal was achieved in 28 cases (66%) and was significantly associated with combined approaches (77% vs 50%, P < .05).

CONCLUSIONS

The choice of a combined approach to anterior gyrus cinguli tumors is critical to improving the quality of resection in selected cases. We recommend a combined approach in the surgical treatment of large tumors of the perigenual area.