Cingulate gyrus surgery
J.Sales-Llopis
Neurosurgery Department, University General Hospital of Alicante, Spain
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The surgery may involve removing a portion of the cingulate gyrus to treat epilepsy or a brain tumor. Alternatively, the surgery may involve inserting electrodes into the cingulate gyrus to treat chronic pain or psychiatric disorders such as depression and obsessive-compulsive disorder.
As with any surgery, cingulate gyrus surgery carries risks, including bleeding, infection, and damage to surrounding brain tissue. Recovery time and outcomes vary depending on the type and extent of the surgery, as well as the patient's overall health and individual circumstances. It is important to discuss the risks and benefits of cingulate gyrus surgery with a qualified neurosurgeon or medical professional before making any decisions about treatment.
A gross-total resection of a cingulate gyrus glioma is often possible and acceptably safe; intraoperative monitoring and neuronavigation are helpful adjuncts.
Administration of the Stroop test during resection of gliomas involving the anterior cingulate cortex (ACC) in adult patients is an option for intraoperative monitoring of executive functions during awake surgery. Globally, these results suggest functional compensation, mediated by plasticity mechanisms, by contralateral homologous regions of the ACC in adult patients with frontal glioma 1).
Approaches
Videos
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This case is a left sided cingulate gyrus glioma in a 15 year old patient with seizures as the presenting symptom.
Dura opening (Second 26)
The dura is opened in a U-shaped fashion and flapped toward the sagittal sinus. This allows for careful inspection for arachnoid granulations and cortical veins draining into the sinus as midline is approached.
At this stage the venous anatomy along the midline can be carefully assessed.
Interhemispheric fissure (Second 36)
Arachnoid bands tethering these veins are sharply dissected. There are usually multiple corridors between for interhemispheric dissection. If at all possible, no draining veins are sacrificed. A self retaining retractor was not placed along the medial edge of the exposed hemisphere.
For a discussion about retractorless surgery we recommend
The quiet revolution: retractorless surgery for complex vascular and skull base lesions.
The cortex is buffered by a Telfa patty prior to retractor placement. A retractor along the falx to widen the operative field is not indicated to avoid cerebral venous sinus thrombosis.
Pericallosal cistern dissection (Minute 1:20)
Tumor debulking (Minute:2:00)
Outcome
In case of resection of gliomas arising from the anterior cingulate gyrus a supplementary motor area syndrome has to be considered, particularly when the tumor extends to the supracingular cortex.
Postoperatively, patients in 13 cases suffered from a transient supplementary motor area syndrome (34%), all of whom had tumors in the anterior cingulate gyrus. In the early postoperative period (30 days) a new deficit occurred in 5 cases (13%, mild motor deficits or aphasic symptoms). One patient had a major bleeding episode 2 days after surgery and was in a persistent vegetative state.
A > 90% resection was achieved in 32 (84%) and > 70% in another 5 (13%) cases 2).
Diffuse intravenous thrombosis induced by cortical vein injury and prolonged brain retraction may be important causes of unexpected delayed postoperative intracerebral hematoma in surgery using the interhemispheric or subtemporal approach 3).