Initial experience with mierosurgeries through direct Sylvian rtssure approach

Abstract

ObJective To summarize the microsurgieal techniques through direct Sylvian fissure approach. Methods A retrospective analysis was conducted in 62 patients undergoing microsurgeries through direct Sylvian fissure approach, including 4 with cavernous angioma in the Sylvian fissure, 5 with insular lobe tumors, 33 with middle cerebral artery aneurysms, 15 with glioma spanning or invading the Sylvian fissure, 1 with metastatic tumor, 2 with arteriovenous malformations, and 2 with temporal lobe epilepsy. Results All the vascular lesions were exposed satisfactorily and managed appropriately. Of the 19 cases ofgliomas and metastatic tumors, total resection was achieved in 13 cases, and subtotal resection in 6 cases. Transient aphasia or hemiparesis occurred postoperatively in a few patients but all recovered within 1 or two months. Conclusions The Sylvian fissure provides a good surgical route as a subarachnoid space between the frontal, parietal, temporal and insular lobes. The Sylvian fissure should be carefully separated under the operating microscope with high-power magnification, and tension-free retaction is critical in important language areas. In the management of tumors involving the Sylvian fissure, we recommend that extended resection be performed after exposure and appropriate preservation of important blood vessels in the fissure. Key words: Sylvian fissure; Anatomy; Microsurgery