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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Trigonal approach to the lateral ventricle and pathologies of the white matter – surgical strategies using TMS and fibertracking

Trigonaler Zugang zu Pathologien im Hinterhorn und Trigonum – die chirurgische Planung mittels TMS und Fibertracking

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  • presenting/speaker Bernardo Reyes Medina - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
  • presenting/speaker Stefan Linsler - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
  • Sebastian Senger - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
  • Joachim Oertel - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV247

doi: 10.3205/22dgnc239, urn:nbn:de:0183-22dgnc2391

Published: May 25, 2022

© 2022 Reyes Medina et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Eloquent neural structures including white matter tracts surround the trigone of the lateral ventricle. Surgical resection of trigonal tumors via the transparietal approach may cause neurological deterioration depending on the trajectory.

Methods: We retrospectively reviewed patients with trigonal tumors that underwent combined preoperative navigated transcranial magnetic stimulation (nTMS) and tractography.

Results: Five patients underwent preoperative nTMS motor mapping, rTMS language mapping, nTMS-derived corticospinal tract tractography, and optic radiation tractography. The information was used to select the optimal trajectory for a transparietal approach and for intraoperative neuronavigation. Four patients underwent surgical resection. None of them experienced a new permanent deficit.

Conclusion: Combination of preoperative nTMS and tractography facilitates the identification of the optimal parietal trajectory towards the trigone. It allows for sparing of visual and motor pathways as well as cortical language areas.