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Year : 2012  |  Volume : 60  |  Issue : 4  |  Page : 385--389

The transylvian trans-insular approach to lateral thalamic lesions

Department of Neurosurgery, Neurosurgical Clinics, Kamayani Hospital, Agra, India

Correspondence Address:
Shashwat Mishra
A-31, Gyandeep Apartments, Mayur Vihar Phase-1, New Delhi-91
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.100725

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Background: 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. Aims: To describe the approach emphasizing its anatomical basis and also to evaluate its safety and efficacy. Settings and Design: Retrospective study conducted at a tertiary hospital. Materials and Methods: 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. Results: 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. Conclusions: 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.


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Online since 20th March '04
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