Parasagittal Approach

Indications

• Parasagittal approaches are used to treat lesions located near the falx, interhemispheric fissure, or corpus callosum. These lesions often include parasagittal and falcine meningiomas, intraaxial tumors, cavernomas, and arteriovenous malformations (AVMs). The parasagittal approach is also the first step in the transcallosal approach to access lesions in the lateral ventricle, upper aspect of the thalamus through the lateral ventricle, or third ventricle ( Fig. 13.1 ).

• Surgical intervention should be considered for tumors that exhibit growth, significant mass effect, cause neurologic deficit, cause uncontrolled seizures, or are suspicious for primary or secondary malignancy without previous diagnosis.

• Surgical treatment of AVMs in this area is a challenge because the risk of hemorrhage is greater than in other cortical locations, but surgery itself can carry a high morbidity.