Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey.
Oper Neurosurg (Hagerstown). 2021 Jul 15;21(2):48-56. doi: 10.1093/ons/opab095.
Falcotentorial meningiomas are surgically challenging. Currently accepted approaches include occipital interhemispheric and supracerebellar infratentorial approaches, which have documented drawbacks.
To propose an alternative approach to the posterior tentorial incisural space, the interhemispheric precuneus retrosplenial transfalcine approach (IPRTA).
A total of 6 colored-silicone-injected adult cadaveric heads were dissected. We measured the interval between bridging veins and studied computed tomography venography scans of 20 subjects to confirm the feasibility of the IPRTA. Bony landmarks, the region's bridging veins, and the anterior and posterior borders of the approach were identified. The surgical corridor widths (veins' interval) and lengths were compared between alternative midline approaches. We also reviewed 4 consecutive clinical cases using this approach.
The IPRTA provides the shortest distance to the anterior and posterior limits of the posterior tentorial incisura. Moreover, it is the only approach that provides direct visualization of the anterior and posterior limits of falcotentorial junction meningiomas. In all specimens and patients, a minimum 30-mm interval between the anterior and posterior parietal veins was found in at least one of the hemispheres. Tumor removal was successful in all 4 patients but resulted in mild paresthesia in the lower extremities of 2 patients and temporary foot drop in 1 patient.
The IPRTA offers the shortest and most direct corridor for falcotentorial meningiomas and provides excellent visualization of most of the critical structures in the region. Detailed preoperative evaluation of the deep and superficial venous structures is recommended.
颅后窝-天幕脑膜瘤的手术极具挑战性。目前可采用枕叶间脑入路和小脑上蚓部下小脑幕入路，但这两种方法都存在一定的弊端。
提出一种新的天幕切迹内后颅窝入路方法，即间脑穹窿体后胼胝体经脉络膜裂入路（IPRTA）。
对 6 具彩色硅酮灌注成人尸头进行解剖，测量桥静脉之间的距离，并对 20 名受试者的 CT 静脉造影扫描进行研究，以确认 IPRTA 的可行性。确定了骨性标志、该区域的桥静脉以及入路的前后边界。比较了各种中线入路的手术通道宽度（静脉间距）和长度。我们还回顾了使用该入路的 4 例连续临床病例。
IPRTA 提供了到达天幕切迹前后缘的最短距离。此外，它是唯一能够直接观察到颅后窝-天幕交界脑膜瘤前后缘的入路。在所有标本和患者中，至少在一个半球中发现了前顶静脉和后顶静脉之间最小 30mm 的间隔。4 例患者的肿瘤均成功切除，但 2 例患者下肢出现轻度感觉异常，1 例患者出现暂时性足下垂。
IPRTA 为颅后窝-天幕脑膜瘤提供了最短、最直接的通道，并能很好地观察到该区域的大多数关键结构。建议对深部和浅部静脉结构进行详细的术前评估。
