CORRESPONDENCE view into the lateral and deep margins of the lesion that often In Reply: Contralateral Anterior comprise the most difficult and dangerous parts of the dissection. Interhemispheric Approach to Medial Frontal The advantages of this unique trajectory outweigh the disadvan- Arteriovenous Malformations: Surgical tages of increased dissection distance, in our opinion, and drive Technique and Results our increasing use. As stated in our paper, the hardest part is taking that initial step to perform a contralateral approach and put the To the Editor: We appreciate the letter from Atul Goel about our lesion further away from you. This letter demonstrates that some neurosurgeons find it valuable and others find it cumbersome, manuscript. His work from 1995, entitled “The Transfalcine Approach to a Contralateral Hemispheric Tumor,” is well and in the end, the curious neurosurgeon must be willing to try known, and applied the approach to 2 parieto-occipital gliomas, it and judge for himself/herself. 1 trigonal choroidal plexus papilloma, and a medial frontal abscess. He will be happy to learn that his paper was cited in our other publication on contralateral interhemispheric Disclosure approaches entitled, “Contralateral Posterior Interhemispheric The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Approach to Deep Medial Parieto-occipital Vascular Malfor- mations: Surgical Technique and Results.” We apologize for the lack of a citation in our Contralateral Anterior Interhemi- Michael T. Lawton, MD spheric Approach (CAIA) paper, and omitted it only because the Department of Neurological Surgery focus of his paper was more posterior than anterior, and more Barrow Neurological Institute Contralateral Posterior Interhemispheric Approach than CAIA. Phoenix, Arizona The benefits of contralaterality apply equally to both anterior or posterior approaches, and we duly acknowledge Dr Goel’s REFERENCES contribution. 1. Goel A. Letter: Contralateral anterior interhemispheric approach to medial His comments about the bilateral parafalcine approach are frontal arteriovenous malformations: surgical technique and results. Oper Neurosurg. interesting. We have not found it necessary to shift to the 2017;14(3):E45. ipsilateral side for superficial dissection. Not only does this 2. Hafez A, Raygor KP, Lawton MT. Contralateral anterior interhemispheric additional dissection endanger other veins, including the draining approach to medial frontal arteriovenous malformations: surgical technique and results. Oper Neurosurg. 2017;13(4):413-420. veins of an arteriovenous malformation (as seen in his drawing), 3. Goel A. Transfalcine approach to a contralateral hemispheric tumour. Acta but the operative corridor closes when the midline is positioned Neurochir (Wein). 1995;135:210-212. horizontally and gravity acts on the ipsilateral hemisphere. Also 4. Burkhardt JK, Winkler E, Lawton MT. Contralateral posterior interhemispheric interesting is Dr Goel’s disenchantment with the contralateral approach to deep medial parietooccipital vascular malformations: surgical technique and results. JNeurosurg. 2017;1-7. approaches over time, which he attributes to increased dissection distances and risks to the contralateral hemisphere. While there is no remedy for the additional risk to the contralateral hemisphere, 10.1093/ons/opx248 we have become increasingly enamored with the “cross court” OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 3 | MARCH 2018 | E45 Downloaded from https://academic.oup.com/ons/article-abstract/14/3/E45/4675057 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Operative Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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