Microsurgical endoscope-assisted gravity-aided transfalcine approach for contralateral metastatic deep medial cortical tumors

BACKGROUND: Traditional approaches to deep medial cortical tumors utilize transcortical or ipislateral interhemispheric approaches, which can result in cortical damage or retraction injury. To reduce these risks, the microscopic transfalcine approach has been previously described. OBJECTIVE: To describe this approach performed with endoscopic assistance for metastatic tumor resection, demonstrating appropriate and safe tumor resection without injury to the contralateral hemisphere. METHODS: Eleven consecutive patients harboring medial, deep metastatic tumors are reported. Tumor resection was performed with endoscopic assistance with 2 surgeons. Clinical outcomes are recorded. RESULTS: All 11 patients underwent safe tumor resection. Gross total resection was achieved in 73% of patients. The application of the angled endoscope allowed for further tumor resection in 91% of patients. There were no complications in these patients. The contralateral brain did not demonstrate clinical or radiographic injury as well. CONCLUSION: This series suggests that the endoscopic transfalcine approach in the lateral position can be a safe and effective approach for resecting medial interhemispheric metastatic tumors. It allows excellent tumor visualization, eliminates the need for brain retraction, minimizes parenchymal transgression, and improves surgical ergonomics. A familiarity of endoscopy and neuroanesthesia support is helpful when utilizing this approach.