Anatomical correlates and Surgical experience with Goel orbital cortical approach to caudate head tumors.

Abstract: Objective We analyzed cortical landmarks, trajectory of approach and various fiber tracts in the vicinity of our earlier described approach through the orbital/basal surface of the frontal lobe to access tumors located in the region of caudate nucleus. We also present a new lateral orbital trajectory to approach these tumors. Methods The orbital surfaces of three formalin fixed and frozen cadaveric brain specimens were dissected to decipher the white fibers in the region of the caudate nucleus. Safe trajectories to lesions of the head of the caudate nucleus were identified and the anatomical landmarks of the approach were evaluated. Three patients with caudate head tumors were operated using this approach. Results The caudate head lies at an average distance of 34 mm from the tip of the frontal pole, 24 mm from the basal medial orbital surface of the frontal lobe, 35 mm from the basal lateral orbital surface and 37 mm from the superior surface of the frontal lobe. Two avenues were identified to approach the caudate head, one by making a cortical incision in the lateral orbital gyrus (lateral orbital approach) and the second by making a corticectomy in the medial orbital gyrus (medial orbital approach) in line with the temporal pole. All the three patients were operated successfully using this approach. Conclusions Surgical approach to the caudate head through the orbital surface of the frontal lobe as described by us provides the shortest trajectory and safe surgical route to access tumors of the caudate nucleus.