Abstract
Surgical treatment of ventricular atrial tumors can be challenging for neurosurgeons because of their deep location. Multiple surgical approaches have been described to resect lesions in the atrium, including the intraparietal transsulcal approach,1 the transtemporal approach,2 and the posterior interhemispheric transprecuneus approach3; these approaches have advantages and disadvantages but can be associated with high morbidity specially when the lesion is in the dominant hemisphere. In this surgical video, we describe the anterior interhemispheric contralateral approach for an atrial meningioma in a 55year-old female patient who consented the procedure and to the publication of her image. The anterior interhemispheric approach for atrial tumors uses a trajectory that comes down the long axis of the tumor, requiring less brain manipulation. The patient is positioned supine with the head maximally turned and the tumor side up; the gravity allows the contralateral frontal lobe to fall away from the falx. Proper positioning and gravity will give the surgeon an almost orthogonal view of the atrial tumor once the coronally oriented callosotomy is done under navigation. The anterior trajectory avoids the encounter of multiple interhemispheric veins draining into the superior sagittal sinus and reduces the risk of injuring the motor strip. The main disadvantage of this approach is the disconnection syndrome, but with a coronal oriented callosotomy, the transgression of tissue is less, and patients usually recover without residual deficits. The interhemispheric contralateral approach is a feasible option for atrial tumors especially when they are located in the dominant hemisphere.