Anatomical issues related to the transcortical versus the trans-sulcal approach to intra-axial brain tumors: a fiber dissection study
Shah, Abhidha Jhawar, Sukhdeep Goel, Aimee Goel, Atul
Shah, Abhidha
Jhawar, Sukhdeep
Goel, Aimee
Goel, Atul
Abstract
Objective: We aimed to evaluate the white fiber anatomy of the transcortical and the trans-sulcal avenue to approach intrinsic and deep-seated lesions in the cerebral hemisphere.
Material and methods: Klingler's method of white fiber dissection was used to study the subcortical anatomy on ten formalin fixed frozen cadaveric brain specimens. The approaches were studied on the lateral aspect of the hemisphere. The short arcuate fibers that would have to be transacted when an incision was taken into the cortex through the dome of the gyrus and when an incision was taken in the depths of the sulcus or via a trans-sulcal approach were studied. The white fiber pathways particularly the deeper long association fibers that would be transected when adopting transcortical or trans-sulcal approaches were studied.
Results: The transcortical approach primarily risks injury to intragyral fibers. In contrast, the transsulcal approach places the intergyral fibers at risk-short association fibers that connect adjacent gyri and serve as important interfaces between short and long association fiber systems. Additionally, transsulcal approaches necessitate manipulation of sulcal vessels, increasing the risk of vascular injury.
Conclusions: For deep-seated intra-axial lesions, the transsulcal approach disrupts intergyral connectivity and the interface between short and long association fibers, in addition to posing vascular risks. A transcortical approach through non-eloquent cortex preferentially disrupts intragyral fibers and avoids sulcal vascular manipulation. From a white matter anatomical perspective, the transcortical approach may be better suited for selected deep intra-axial tumors.
MIDER Authors
Date
2026-03-03
Type
Article
Subject
Brain neoplasms
Collections
Citation
Shah A, Jhawar S, Goel A, Goel A. Anatomical issues related to the transcortical versus the trans-sulcal approach to intra-axial brain tumors: A fiber dissection study. J Clin Neurosci. 2026 Jun;148:111969. doi: 10.1016/j.jocn.2026.111969. Epub 2026 Mar 3
Journal / Source Title
Journal of Clinical Neuroscience
DOI
10.1016/j.jocn.2026.111969
PMID
41780110
Publisher
Churchill Livingstone
Publisher’s URL
https://www.sciencedirect.com/journal/journal-of-clinical-neuroscience