Cortical incisions and transcortical approaches for intra-axial and intraventricular lesions: A scoping review

Abstract

Background: Transcortical approaches, encompassing various surgical corridors, have been employed to treat an array of intraparenchymal or intraventricular brain pathologies, including tumors, vascular malformations, infections, intracerebral hematomas, and epileptic surgery. Designing cortical incisions relies on the lesion location and characteristics, knowledge of eloquent functional anatomy, and advanced imaging such as tractography. Despite their widespread use in neurosurgery, there is a noticeable lack of systematic studies examining their common lobe access points, associated complications, and prevalent pathologies. This scoping review assesses current evidence to guide the selection of transcortical approaches for treating a variety of intracranial pathologies.

Methods: A scoping review was conducted using the PRISMA-ScR guidelines, searching PubMed, EMBASE, Scopus, and Web of Science. Studies were included if ≥5 patients operated on using transcortical approaches, with reported data on clinical features, treatments, and outcomes. Data analysis and synthesis were performed.

Results: A total of 50 articles encompassing 2604 patients were included in the study. The most common primary pathology was brain tumors (60.6%), particularly gliomas (87.4%). The transcortical-transtemporal approach was the most frequently identified cortical approach (70.48%), and the temporal lobe was the most accessed brain lobe (55.68%). The postoperative course outcomes were reported as good (55.52%), poor (28.38%), and death (14.62%).

Conclusion: Transcortical approaches are crucial techniques for managing a wide range of intracranial lesions, with the transcortical-transtemporal approach being the most common. According to the current literature, the selective choice of cortical incision and surgical corridor based on the lesion's pathology and anatomic-functional location correlates with acceptable functional outcomes.

Keywords: Intracranial lesions; Surgical approach; Transcortical approaches; Transcortical transtemporal.

Figure 1:

PRISMA flow chart of the studies.

Figure 2:

Coronal section of the cerebrum shows different pathologies. (1) glioma, (2) temporal horn of lateral ventricular tumor, (3) temporal lobe tumor, (4) frontal horn of lateral ventricular tumor, (5) third ventricular tumor, (6) paraventricular arteriovenous malformations (AVM), (7) intraventricular AVM, (8) thalamic intracerebral hemorrhage, (9) temporal lobe AVM, and (10) mesial temporal epilepsy.

Figure 3:

Artistic depiction exhibits the lateral surface of the left hemisphere and medial surface of the right hemisphere with the marking of the cortical incisions of (1) inferior temporal sulcus, (2) middle temporal gyrus, (3) superior temporal sulcus, (4) middle frontal gyrus, (5) precentral sulcus, (6) postcentral sulcus, (7) superior parietal lobule, and (8) cingulate gyrus.