Tag: corpus callosum

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Awake surgery for IDH-mutant grade 2 glioma involving the corpus callosum: long-term onco-functional results after callosectomy in 157 consecutive patients

J Neurosurg 143:1280–1289, 2025

This clinical study reports outcomes from 157 consecutive patients with IDH‑mutant grade 2 gliomas infiltrating the corpus callosum who underwent connectome-guided awake surgery with callosectomy. It summarizes surgical technique, extent of resection, complication rates, return-to-work statistics, histology, adjuvant treatments, reoperations, and long-term overall survival.

Comparative analysis contrasts complete (total/supratotal) versus incomplete resections, showing higher extent of resection, greater reoperation potential, and longer median overall survival when callosal tumor was fully removed, while preserved function and a 96.8% return-to-work rate underline favorable onco-functional balance.

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Surgical removal of a corpus callosum arteriovenous malformation using a robotic digital microscope

Acta Neurochirurgica (2023) 165:1609–1613

This report described the surgical nuance of a challenging deep-seated corpus callosum arteriovenous malformation (AVM) using a novel robotic digital microscope.

Method A 64-year-old male was admitted to treat a ruptured corpus callosum AVM. In order to facilitate surgical manipulation under the robotic digital microscope, a gravity-assisted supine position was utilized. Intraoperatively, identifying and preserving the transit and bystander artery is important while skeletonizing the anterior cerebral artery. The nidus was totally resected and the patient was discharged without sequella.

Conclusion It is feasible to perform complicated AVM resection under the robotic digital microscope with a rigorous surgical plan.

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Improved outcomes associated with maximal extent of resection for butterfly glioblastoma

Acta Neurochirurgica (2021) 163:1883–1894

Butterfly glioblastomas (bGBMs) are grade IV gliomas that infiltrate the corpus callosum and spread to bilateral cerebral hemispheres. Due to the rarity of cases, there is a dearth of information in existing literature. Herein, we evaluate clinical and genetic characteristics, associated predictors, and survival outcomes in an institutional series and compare them to a national cohort.

Methods We identified all adult patients with bGBM treated at Brigham & Women’s Hospital (2008–2018). The National Cancer Database (NCDB) was also queried for bGBM patients. Survival was analyzed with Kaplan–Meier methods, and Cox models were built to assess for predictive factors.

Results Of 993 glioblastoma patients, 62 cases (6.2%) of bGBM were identified. Craniotomy for resection was attempted in 26 patients (41.9%), with a median volumetric extent of resection (vEOR) of 72.3% (95% confidence interval [95%CI] 58.3–82.1). The IDH1 R132H mutation was detected in two patients (3.2%), and MGMT promoter was methylated in 55.5% of the assessed cases. In multivariable regression, factors predictive of longer OS were increased vEOR, MGMT promoter methylation, and receipt of adjuvant therapy. Median OS for the resected cases was 11.5 months (95%CI 7.7–18.8) vs. 6.3 (95%CI 5.1–8.9) for the biopsied. Of 21,353 GBMs, 719 (3.37%) bGBM patients were identified in the NCDB. Resection was more likely to be pursued in recent years, and GTR was independently associated with prolonged OS (p < 0.01).

Conclusion Surgical resection followed by adjuvant chemoradiation is associated with significant survival gains and should be pursued in carefully selected bGBM patients.

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Mapping and anatomo-surgical techniques for SMA-cingulum-corpus callosum gliomas

Acta Neurochirurgica (2021) 163:1239–1246

Awake brain mapping paradigms are variable, particularly in SMA, and not personalised to each patient. In addition, subpial resections do not offer full protection to vascular injury, as the pia can be easily violated.

Methods Mapping paradigms developed by a multidisciplinary brain mapping team. During resection, a combined subpial/ interhemispheric approach allowed early identification and arterial skeletonization. Precise anatomo-surgical dissection of the affected cingulum and corpus callosum was achieved.

Conclusions In SMA-cingulum-CC tumours, a combined subpial/interhemispheric approach reduces risk of vascular injury allowing precise anatomo-surgical dissections. Knowledge of cognitive functions of affected parcels is likely to offer best outcomes.

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Contralateral anterior interhemispheric transcallosal- transrostral approach to the subcallosal region

J Neurosurg 129:508–514, 2018

The authors report a novel surgical route from a superior anatomical aspect—the contralateral anterior interhemispheric-transcallosal-transrostral approach—to a lesion located in the subcallosal region. The neurosurgical approach to the subcallosal region is challenging due to its deep location and close relationship with important vascular structures. Anterior and inferior routes to the subcallosal region have been described but risk damaging the branches of the anterior cerebral artery.

METHODS Three formalin-fixed and silicone-injected adult cadaveric heads were studied to demonstrate the relationships between the transventricular surgical approach and the subcallosal region. The surgical, clinical, and radiological history of a 39-year-old man with a subcallosal cavernous malformation was retrospectively used to document the neurological examination and radiographic parameters of such a case.

RESULTS The contralateral anterior interhemispheric-transcallosal-transrostral approach provides access to the subcallosal area that also includes the inferior portion of the pericallosal cistern, lamina terminalis cistern, the paraterminal and paraolfactory gyri, and the anterior surface of the optic chiasm. The approach avoids the neurocritical perforating branches of the anterior communicating artery.

CONCLUSIONS The contralateral anterior interhemispheric-transcallosal-transrostral approach may be an alternative route to subcallosal area lesions, with less risk to the branches of the anterior cerebral artery, particularly the anterior communicating artery perforators.

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Contralateral posterior interhemispheric approach to deep medial parietooccipital vascular malformations

J Neurosurg 129:198–204, 2018

Deep medial parietooccipital arteriovenous malformations (AVMs) and cerebral cavernous malformations (CCMs) are traditionally resected through an ipsilateral posterior interhemispheric approach (IPIA), which creates a deep, perpendicular perspective with limited access to the lateral margins of the lesion. The contralateral posterior interhemispheric approach (CPIA) flips the positioning, with the midline positioned horizontally for retraction due to gravity, but with the AVM on the upper side and the approach from the contralateral, lower side. The aim of this paper was to analyze whether the perpendicular angle of attack that is used in IPIA would convert to a parallel angle of attack with the CPIA, with less retraction, improved working angles, and no significant increase in risk.

METHODS A retrospective review of pre- and postoperative clinical and radiographic data was performed in 8 patients who underwent a CPIA.

RESULTS Three AVMs and 5 CCMs were resected using the CPIA, with an average nidus size of 2.3 cm and CCM diameter of 1.7 cm. All lesions were resected completely, as confirmed on postoperative catheter angiography or MRI. All patients had good neurological outcomes, with either stable or improved modified Rankin Scale scores at last follow-up.

CONCLUSIONS The CPIA is a safe alternative approach to the IPIA for deep medial parietooccipital vascular malformations that extend 2 cm or more off the midline. Contralaterality and retraction due to gravity optimize the interhemispheric corridor, the surgical trajectory to the lesion, and the visualization of the lateral margin, without resection or retraction of adjacent normal cortex. Although the falx is a physical barrier to accessing the lesion, it stabilizes the ipsilateral hemisphere while gravity delivers the dissected lesion through the transfalcine window. Patient positioning, CSF drainage, venous preservation, and meticulous dissection of the deep margins are critical to the safety of this approach.

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A method for safely resecting anterior butterfly gliomas

J Neurosurg 126:1795–1811, 2017

Gliomas invading the anterior corpus callosum are commonly deemed unresectable due to an unacceptable risk/benefit ratio, including the risk of abulia. In this study, the authors investigated the anatomy of the cingulum and its connectivity within the default mode network (DMN). A technique is described involving awake subcortical mapping with higher attention tasks to preserve the cingulum and reduce the incidence of postoperative abulia for patients with so-called butterfly gliomas.

METHODS The authors reviewed clinical data on all patients undergoing glioma surgery performed by the senior author during a 4-year period at the University of Oklahoma Health Sciences Center. Forty patients were identified who underwent surgery for butterfly gliomas. Each patient was designated as having undergone surgery either with or without the use of awake subcortical mapping and preservation of the cingulum. Data recorded on these patients included the incidence of abulia/akinetic mutism. In the context of the study findings, the authors conducted a detailed anatomical study of the cingulum and its role within the DMN using postmortem fiber tract dissections of 10 cerebral hemispheres and in vivo diffusion tractography of 10 healthy subjects.

RESULTS Forty patients with butterfly gliomas were treated, 25 (62%) with standard surgical methods and 15 (38%) with awake subcortical mapping and preservation of the cingulum. One patient (1/15, 7%) experienced postoperative abulia following surgery with the cingulum-sparing technique. Greater than 90% resection was achieved in 13/15 (87%) of these patients.

CONCLUSIONS This study presents evidence that anterior butterfly gliomas can be safely removed using a novel, attention-task based, awake brain surgery technique that focuses on preserving the anatomical connectivity of the cingulum and relevant aspects of the cingulate gyrus.

 

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Microsurgical anatomy of the temporal stem: clinical relevance and correlations with diffusion tensor imaging fiber tracking

J Neurosurg 112:1033–1038, 2010. (DOI: 10.3171/2009.6.JNS08132)

The authors used a fiber dissection technique to describe the temporal stem and explain the tendency of malignant tumors to spread within both the frontal and temporal lobes. The authors focused on the morphological characteristics and course of various fasciculi of the temporal stem, including the uncinate fascicle, occipitofrontal fascicle, anterior commissure, loop of the optic radiations (Meyer loop), and the ansa peduncularis.

Methods. Eight previously frozen, formalin-fixed human brains were dissected under an operating microscope using the fiber dissection technique described by Klingler. Lateral, inferior, and medial approaches were made. Crosssectional 3D MR images obtained in 10 patients without brain lesions demonstrated that fibers of the temporal stem, which were intermingled together in various ways, curved laterally within the basal forebrain. Various pathological entities affecting the temporal stem are described and discussed.

Results. The uncinate fascicle has 3 portions: a ventral extension, an intermediary segment called the isthmus, and a dorsal segment. The inferior occipitofrontal fasciculus is a layer of more superficial white matter that appeared to be superior to the uncinate fasciculus. A short ventral portion of the radiations of the corpus callosum was sometimes noted to run ventrally to enter the temporal stem and to reach both temporal lobes.

Conclusions. To the authors’ knowledge, a detailed anatomy of the temporal stem has not been previously described in the literature. The unique anatomy of the temporal stem provides a route for tumor spread between the frontal and temporal lobes.


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Diffusion Tensor Imaging in Patients With Adult Chronic Idiopathic Hydrocephalus

Neurosurgery 66:917-924, 2010 DOI: 10.1227/01.NEU.0000367801.35654.EC

Diffusion tensor imaging (DTI) parameters were investigated in patients with chronic idiopathic hydrocephalus to evaluate microstructural changes of brain tissue caused by chronic ventricular dilatation.

METHODS: Eleven patients fulfilling the criteria for possible or probable idiopathic normal pressure hydrocephalus and 10 healthy control subjects underwent MRI at 3 Tesla, including DTI with 12 gradient directions. Patients were scanned before lumbar cerebrospinal fluid (CSF) withdrawal tests. Differences in fractional anisotropy (FA) and mean diffusivity (MD) between patients and controls were assessed using 2 different methods: manual definition of regions of interest and a fully automated method, TBSS (Tract-Based Spatial Statistics). DTI parameters were correlated with clinical findings.

RESULTS: Compared with the control group, patients with chronic idiopathic hydrocephalus had significantly higher MD values in both the periventricular corticospinal tract (CST) and the corpus callosum (CC), whereas FA values were significantly higher in the CST but lower in the CC. DTI parameters of the CST correlated with the severity of gait disturbances.

CONCLUSION:Microstructural changes in periventricular functionally relevant white matter structures (CSF, CC) in chronic idiopathic hydrocephalus can be visualized using DTI. Further studies should investigate the change of DTI parameters after CSF shunting and its relation to neurologic outcome.

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Microsurgical anatomy of the ventral callosal radiations: new destination, correlations with diffusion tensor imaging fiber-tracking, and clinical relevance

J Neurosurg 112:512–519, 2010.DOI: 10.3171/2009.6.JNS081712

In the current literature, there is a lack of a detailed map of the origin, course, and connections of the ventral callosal radiations of the human brain.

Methods. The authors used an older dissection technique based on a freezing process as well as diffusion tensor imaging to investigate this area of the human brain.

Results. The authors demonstrated interconnections between areas 11, 12, and 25 for the callosal radiations of the trunk and rostrum of the corpus callosum; between areas 9, 10, and 32 for the genu; and between areas 6, 8, and 9 for the ventral third of the body. The authors identified new ventral callosal connections crossing the rostrum between both temporal poles and coursing within the temporal stem, and they named these connections the “callosal radiations of Peltier.” They found that the breadth of the callosal radiations slightly increases along their course from the rostrum to the first third of the body of the corpus callosum.

Conclusions. The fiber dissection and diffusion tensor imaging techniques are complementary not only in their application to the study of the commissural system in the human brain, but also in their practical use for diagnosis and surgical planning. Further investigations, neurocognitive tests, and other contributions will permit elucidation of the functional relevance of the newly identified callosal radiations in patients with disease involving the ventral corpus callosum.

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