Surgical approaches to tumors of the anterior gyrus cinguli.

BACKGROUND: Tumors of the gyrus cinguli are deep-seated, and may require a variety of surgical options. We focused on anterior tumors, which have specific anatomic and surgical features. OBJECTIVE: To evaluate different approaches and indications through detailed description and a review of our experience. METHODS: These approaches include unilateral interhemispheric or combined: bilateral interhemispheric, unilateral plus superior frontal gyrectomy, or unilateral plus frontal polectomy. The relevance of this retrospective analysis is stressed by the extremely limited literature in this regard. RESULTS: In the past 5 years we operated on 38 patients with gliomas. We compared the following variables: location (perigenual, prerolandic), pathology (glioblastoma, other gliomas), size ( or =4 cm), extension (unilateral, bilateral), and approach (unilateral interhemispheric, combined). The only significant association we found was between tumor location (perigenual) and bilateral extension (P < .01). However, combined approaches were adopted only slightly more frequently in this region than in the prerolandic area, and this resulted in a lower rate of total removal (33\% vs 76\%, P < .01). Gross total removal was achieved in 28 cases (66\%) and was significantly associated with combined approaches (77\% vs 50\%, P < .05). CONCLUSIONS: The choice of a combined approach to anterior gyrus cinguli tumors is critical to improving the quality of resection in selected cases. We recommend a combined approach in the surgical treatment of large tumors of the perigenual area