Operative Neurosurgery 29:495–504, 2025
This retrospective case series evaluates the contralateral interhemispheric transfalcine approach (PITTA) for medial parietooccipital and peritrigonal brain lesions. The technique offers improved visualization and minimized brain manipulation, with acceptable complication rates, but requires careful venous management and is best suited for experienced neurosurgeons.
The contralateral interhemispheric transfalcine (PITTA) approach is used for challenging medial parietooccipital and peritrigonal brain lesions.
• A retrospective study of 19 cases showed PITTA was applied to vascular lesions (AVMs) and tumors (glioblastomas, meningiomas, metastases, pilocytic astrocytoma).
• The approach improves visualization and reduces manipulation of eloquent cortex and white matter compared to traditional ipsilateral approaches.
• Mean surgery time was about 4 hours 15 minutes, and most patients had temporary neurological deficits that resolved within days.
• Superior sagittal sinus injury and small vein sacrifice occurred in a few cases but were managed without lasting complications.
• No new visual deficits or permanent ipsilateral parietal lobe injuries were observed; most complications were minor and transient.
• PITTA is technically demanding and best suited for experienced neurosurgeons; careful preoperative planning and venous anatomy assessment are critical.
• The study concludes PITTA is a valuable option for selected cases, but larger prospective studies are needed to compare it with standard approaches.
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