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Amenability of transfrontal approach for all midline and brainstem stereotactic surgery

Author: 
Mohamed Hasan Mansour, and Mamon Aboshosha
Subject Area: 
Health Sciences
Abstract: 

Background: An ipsilateral transfrontal entry point provides access to the mesencephalon and midline regions of the pons. A contralateral transfrontal entry point has also been described that allows access to more laterally placed pontine lesions without having to traverse the ventricular system. Both ipsilateral and contralateral approaches allow the patient to remain supine during surgery, in a similar position to that in which images are traditionally acquired thus preventing error due to positional brain shift. In this region, a burrhole can be placed without painful muscle dissection and twist drill holes can be planned to avoid sulci. Objective: The purpose of this study was to study the Amenability of transfrontal trajectory for all midline and brainstem stereotactic surgery. Methods: The study evaluated 60 patients submitted to stereotactic surgery. The most common site of midline lesions was brainstem, in 24 cases (40%) then thalamus in 21 cases (35%) and 10 (16.66%) patients presented by ganglionic lesions (including pallidotomy surgery) and 5 (8.33%) patients presented by craniopharyngioma. The transfrontal approach was used for all patients. Results: Regarding complications of transfrontal approach of stereotactic surgery for midline lesions, the morbidity rate was 3.33% (2 cases) indicating that transfrontal approach is safe and amenable for stereotactic surgery for midline lesions including brainstem lesions. Conclusion: In this study, we provide evidence that the transfrontal approach is a reliable and safe approach to midline lesions of the brain with a high diagnostic success rate and no permanent surgery-related morbidity. Considering some technical issues the approach is simple to perform in a routine procedure without any technical modification.

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