Occipital Lobectomy Utilizing Parieto-Occipital Fissure: Two-Dimensional Operative Video

Occipital lobectomy is a widely accepted procedure for treatment of occipital gliomas and occipital lobe epilepsy,¹^,² but its technical nuances are not well discussed. Anatomically, the occipital lobe, also known as the cuneus or visual area, is an isolated region in terms of vascular supply. The terminal branches of posterior cerebral arteries, including parieto-occipital and calcarine arteries,^3-6 are the major vessels supplying this region. The parieto-occipital fissure (POF) comprises the anterior border of the occipital lobe and has been identified as a useful landmark for glioma invasion and tumor resection.^7-13 In recent years, glioma surgery focused on achieving an extent of resection beyond gross total resection.^14-16 Therefore, focusing on the POF during occipital lobectomy enables handling feeding arteries before tumor resection and accurately defining the resection boundaries beyond the contrast-enhanced lesion, considering the highly invasive nature of glioblastoma. A right-handed 57-year-old man presented with left homonymous hemianopsia. Radiological assessment demonstrated a highly vascular tumor with random enhancement in the right occipital lobe, suggestive of glioblastoma. Computed tomography angiography indicated that the parieto-occipital arteries ran anteriorly to the tumor, and the calcarine artery was identified as the main feeder of the tumor. The surgical procedure involved the dissection of the entire POF along with the parieto-occipital artery and early coagulation of the calcarine artery (Video 1). Postoperative magnetic resonance imaging confirmed the occipital lobectomy with the POF as the anterior border of the resection cavity. The patient exhibited no new neurological deficits postoperatively.