Abstract
Exposure of the anterior skull base is challenging due to strategic structures. The interhemispheric approach (IHA) has turned out to be a feasible technique. We report our experience with IHAs in patients with extraaxial lesions (EAL). We performed a retrospective chart review at a tertiary neurosurgical center between April 2009 and March 2020. We included patients with resection of EAL through IHAs concentrating on surgical technique, complete resection rate, postoperative outcome, and complications. Seventy-four patients resected by an IHA were included: 49 (66.2%) frontal (FIA), nine (12.1%) parietooccipital (PIA), and 16 (21.6%) frontobasal IHAs (FBIAs). Median age at time of surgery was 59 years (range 16–88 years), 47 (63.5%) female and 27 (36.5%) male. Complete resection rate was 83.8% (FIA 89.8%, PIA 55.6%, FBIA 81.3%). Rate of new minor deficits was 17.6%, rate of major deficits 5.4%, total rate 23.0%. 51 (68.9%) WHO°I meningiomas, ten (13.5%) WHO°II meningiomas, two (2.7%) WHO°III meningiomas, nine (12.2%) metastases, one (1.4%) sarcoma, and one (1.4%) local adenocarcinoma were resected. Total complication rate was 27.0%. Rate of major complications requiring intervention was 9.6%. Mean follow-up was 34.2 (± 33.2) months. In patients with lesions of the interhemispheric fissure, overall morbidity and complications are comparatively high. Extensions of IHAs with potential even higher morbidity are not necessary though; we support the use of standardized IHAs. Our findings suggest regular usage of relatively feasible IHAs for a satisfying outcome. Invasive, complicated, or contralateral trajectories were not needed.
Highlights
The frontal interhemispheric approach (FIA) exposes a variety of midline pathologies
Neurosurg Rev (2021) 44:2099–2110 approaches [9, 12,13,14, 73], this study aims to highlight the sufficiency of standardized interhemispheric approach (IHA) and the reduction of perioperative morbidity
We analyzed clinical patient files for neurological symptoms, Karnofsky Performance Status Scale (KPSS), postoperative new neurological deficits, postoperative complications, reinterventions, and adverse events according to the Clavien Dindo scale (CDG)
Summary
The frontal interhemispheric approach (FIA) exposes a variety of midline pathologies. The anterior dissection exposes, besides interhemispheric structures, pathologies in the suprasellar and prechiasmatic cistern including craniopharyngiomas [19, 20] and midline meningiomas, such as olfactory groove [53], As an alternative, but more as an extension, the frontobasal interhemispheric approach (FBIA) enables the view on the anterior skull base from the crista galli to the tuberculum sellae anteroposteriorly and from the midline to the sphenoid wing bilaterally. The parietooccipital interhemispheric approach (PIA) enables the resection of pathologies in the peritrigonal or periatrial region. This is challenging due to the depth of the region and due to strategically important structures [12, 37, 65]
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