How I do it: transcortical trans-inferior parietal lobule approach for gliomas of the posterior thalamic and peri-atrial region

Gliomas of the posterior thalamic and peri-atrial region — particularly those involving the pulvinar — pose a distinct surgical challenge, given their proximity to critical vascular and white matter structures. We describe the transcortical trans-inferior parietal lobule approach for posterior thalamic gliomas, planned with neuronavigation and integrated diffusion tensor imaging tractography, illustrated by an index case and two topographic variants. By exploiting projection of the tumor into the atrium or temporal horn of the lateral ventricle as a natural access route, this corridor reaches the pulvinar directly while sparing the main white matter tracts, and affords a comfortable working angle with dynamic retraction.