Department of Neurosurgery, Neurosurgical Clinics, Kamayani Hospital, Agra, India.
Neurol India. 2012 Jul-Aug;60(4):385-9. doi: 10.4103/0028-3886.100725.
Thalamic tumors are rare intracranial tumors. The most common approaches to the thalamus have been directed through the ventricular system, which surrounds it. The transsylvian trans-insular approach to the lateral thalamus has been infrequently described probably because of the vulnerability of the internal capsule, which skirts this part of the thalamus.
To describe the approach emphasizing its anatomical basis and also to evaluate its safety and efficacy.
Retrospective study conducted at a tertiary hospital.
Patient population included all the patients who underwent surgery for the lesions in lateral thalamus using the transylvian trans-insular approach between 2005 and 2011. A trephine craniotomy was made, centered over posterior sylvian fissure and the surgical corridor was developed through the insular cortex.
During the study period 10 patients (7 tumors and inflammatory lesions and 3 hypertensive bleeds) were treated using this approach. One peri-operative mortality was noted. In patients with lesions other than hypertensive thalamic hemorrhage, there was no postoperative worsening of neurological deficit as comparative to preoperative deficits. Total excision/evacuation of the lesion could be accomplished in all the patients.
The transylvian trans-insular approach is safe, effective, anatomical procedure, and can be performed at a peripheral center without the need for navigation and intra-operative monitoring.
丘脑肿瘤是罕见的颅内肿瘤。最常见的进入丘脑的方法是通过脑室系统，脑室系统环绕着丘脑。经外侧裂-岛叶入路到达外侧丘脑的方法很少被描述，可能是因为内囊的脆弱性，内囊绕过了丘脑的这一部分。
描述该入路，强调其解剖学基础，并评估其安全性和有效性。
在一家三级医院进行的回顾性研究。
患者人群包括 2005 年至 2011 年间使用经外侧裂-岛叶入路治疗外侧丘脑病变的所有患者。采用在后侧裂中心开颅，通过岛叶皮质开发手术通道。
在研究期间，有 10 名患者（7 例肿瘤和炎性病变，3 例高血压性出血）采用这种方法治疗。有 1 例围手术期死亡。对于除高血压性丘脑出血以外的病变患者，与术前相比，术后神经功能缺损没有恶化。所有患者均能完成病变的全切/清除。
经外侧裂-岛叶入路是一种安全、有效、解剖学上可行的方法，可以在没有导航和术中监测的情况下在周边中心进行。
