Standard craniotomy under general anesthesia with bridging vein-guided tailored transcortical resection for medial frontal glioma involving the cingulate gyrus: A case report
Abstract
Background: Gliomas of the medial frontal lobe extending into the gyrus cinguli represent a challenging neurosurgical entity because of their deep location, complex vascular anatomy, and proximity to functionally significant cortical and subcortical structures. Awake craniotomy with functional mapping, diffusion tensor imaging (DTI)-based planning, neuronavigation, and cortical/subcortical stimulation represents an important contemporary strategy for maximal safe glioma resection, particularly for tumors located within or near eloquent networks. However, in carefully selected cases, standard microsurgical craniotomy under general anesthesia may remain a valuable option when detailed anatomical and venous assessment identifies a safe operative corridor. Dense frontal bridging veins draining into the superior sagittal sinus may limit standard interhemispheric approaches and influence the selection of an alternative transcortical route.
Case description: We report the case of a 31-year-old right-handed woman presenting with progressive headache, seizures, and urinary incontinence. Preoperative magnetic resonance imaging revealed a large intra-axial tumor of the right medial frontal lobe with extension toward the anterior cingulate gyrus and partial involvement of the corpus callosum. Neuropsychological assessment demonstrated moderate frontal-subcortical cognitive impairment. Preoperative venous imaging identified multiple frontal bridging veins draining into the superior…
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