Brain resection for exposure of deep extracerebral and paraventricular lesions.

In exposing deep extracerebral or paraventricular lesions, it sometimes may be preferable to resect a small amount of noneloquent brain tissue rather than retract the brain. This may be the case in carefully selected instances when, in the surgeon's estimate, brain retraction may result in significant parenchymal damage, in aneurysmal rupture, or in damage to important bridging veins. Some surgical approaches involving brain resection have been well described. This technical note discusses the following approaches that, though undoubtedly used by many surgeons sporadically, have received less formal attention: (1) anterior-inferior temporal resection for basilar aneurysms, (2) posterior-inferior temporal resection to approach the posterior incisura and avoid damage to the vein of Labbé, (3) parahippocampal resection to expose the posterior cerebral artery in the ambient cistern, (4) paramedial posterior parietal incision to approach the trigone of the lateral ventricle, (5) parasagittal resection to expose the interhemispheric fissure and avoid damage to bridging veins, (6) cingulate resection for pericallosal aneurysms, and (7) tonsillar resection for aneurysms of the peripheral portion of the posterior-inferior cerebellar arteries.