A Contralateral Transfalcine Approach to the Mesial Frontoparietal Region and Cingulate Gyrus: A Cadaveric Feasibility Study

Abstract

Neurosurgery for lesions located the mesial frontoparietal region and cingulate gyrus may need significant brain retraction, which may cause neural injury. Therefore, the goal of this anatomic study was to evaluate a contralateral transfalcine approach to these regions. Eight adult cadaver heads were used in this study. An 8× 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 frontoparietal region down to the cingulate gyrus and compared with measurements using a contralateral transfalcine approach to this same region. Ipsilateral approaches required 1.5 to 3 cm of lateral retraction (40-50°) from the midline, whereas contralateral transfalcine approaches required 0.5 to 1 cm of lateral retraction (10-20°). In comparison with the traditional ipsilateral interhemispheric approach to lesions of the mesial frontoparietal 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.