The transylvian trans-insular approach to lateral thalamic lesions

Abstract

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.