Cavernomas de la región temporal mesial: anatomía microquirúrgica y abordajes / Cavernomas of the mesial temporal region: microsurgical anatomy and approaches

Objetivo: describir la anatomía microquirúrgica y los abordajes a la región temporal mesial (RTM), en relación a cavernomas de dicho sector. Material y Método: Cinco cabezas de cadáveres adultos, fijadas en formol e inyectadas con silicona coloreada, fueron estudiadas. Además, desde enero de 2007 a junio de 2014, 7 pacientes con cavernomas localizados en la RTM fueron operados por el autor. Resultados: Anatomía: la RTM fue dividida en 3 sectores: anterior, medio y posterior. Pacientes: 7 enfermos con cavernomas de la RTM fueron operados por el autor. De acuerdo a la ubicación en la RTM, 4 cavernomas se ubicaron en el sector anterior, 2 cavernomas se localizaron en el sector medio y 1 cavernoma se ubicó en el sector posterior. Para el sector anterior de la RTM se utilizó un abordaje transsilviano-transinsular; para el sector medio de la RTM se utilizó un abordaje transtemporal (lobectomía temporal anterior); y para el sector posterior de la RTM se utilizó un abordaje supracerebeloso-transtentorial. Conclusión: Dividir la RTM en 3 sectores nos permite adecuar el abordaje en función a la localización de la lesión. Así, el sector anterior es bien abordable a través de la fisura silviana; el sector medio a través de una vía transtemporal; y el sector posterior por un abordaje supracerebeloso.

Objective: To describe the microsurgical anatomy and approaches to the mesial temporal region (MTR), in relation with cavernomas. Material and Method: Five adult cadaveric heads, fixed in formol and injected with colored silicon were studied. Since January 2007 and June 2014, the author operated 7 patients with cavernomas located in the MTR. Results: Anatomy: the MTR was divided in 3 portions: anterior, middle and posterior. Patients: the author operated 7 patients with MTR cavernomas. Four cavernomas were located in the anterior portion, 2 were located in the middle portion, and 1 cavernoma was located in the posterior portion. The transsylvian-transinsular approach was used for the anterior portion of the MTR; the transtemporal approach (anterior temporal lobectomy) was used for the middle portion of the MTR; and the supracerebellar-transtentorial approach was used for the posterior portion of the MTR. Conclusion: The idea of divide the MTR in 3 portions help to select the correct approach.

Cortical projection of the inferior choroidal point as a reliable landmark to place the corticectomy and reach the temporal horn through a middle temporal gyrus approach / Projeção cortical do ponto coroideo inferior como uma referência anatômica confiável para a realização da corticectomia e abordagem do corno temporal através do giro temporal médio.

Objective To establish preoperatively the localization of the cortical projection of the inferior choroidal point (ICP) and use it as a reliable landmark when approaching the temporal horn through a middle temporal gyrus access. To review relevant anatomical features regarding selective amigdalohippocampectomy (AH) for treatment of mesial temporal lobe epilepsy (MTLE). Method The cortical projection of the inferior choroidal point was used in more than 300 surgeries by one authors as a reliable landmark to reach the temporal horn. In the laboratory, forty cerebral hemispheres were examined. Conclusion The cortical projection of the ICP is a reliable landmark for reaching the temporal horn. .

Objetivo Estabelecer a projeção cortical do ponto coiroideo inferior e usá-la como referência para realizar a corticectomia e a abordagem do corno temporal do ventrículo lateral em cirurgias para o tratamento da epilepsia temporal mesial. Método A projeção cortical do ponto coroideo inferior foi utilizada por um dos autores seniors em mais de 300 casos de epilepsia temporal mesial para atingir o corno temporal do ventrículo lateral. Conclusão A projeção cortical do ponto coroideo inferior foi útil e confiável na abordagem do corno temporal do ventrículo lateral e ela está geralmente localizada na margem inferior do giro temporal médio, em média, a 4,52 cm posterior ao polo temporal. .

Application of MRI volume rendering in surgical approach by superior temporal sulcus-temporal horn of lateral ventricle / 吉林大学学报(医学版)

Objective To acquire some related data of surgical approach through brain superior temporal sulcus to temporal horn of lateral ventricle by MRI volume rendering, and to orientate the point of superior temporal sulcus on the lateral surface which is closest to temporal horn of lateral ventricle,and to find out the best entrance point of surgical approach through superior temporal sulcus to temporal horn of lateral ventricle.Methods 120 adult cases of MRI scanning specimens were chosen for measurement. MRI volume rendering technology was used to rebuild the brain 3D model for the measurement of the full length of superior temporal sulcus S1 .Then cutting along the prependicular to the direction of the long axis of the temporal lobe with 1.0 mm spacings,the coronal sections were obtained,and the distance from superior temporal sulcus to temporal horn of lateral ventricle was ordinally measured and the shortest distance S2 was made sure.And the depth of superior temporal sulcus S3 was detected. The corresponding point on the surface of the brain at superior temporal sulcus according to the point leading the shortest distance S4 was determined. The ratio of S4 to S1 M was calculated. The angle between the shortest distance and median sagittal plane asαwas determined.All the samples were measured on both sides of the brain and all the data were compared.Results The S1 of the 120 cases was (159.56 ± 17.55)mm on the left and (164.35± 15.07)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S2 was (8.18±0.96)mm on the left and (7.81±0.90)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S3 was (12.19±1.43)mm on the left and (11.57± 1.33)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S4 was (100.88±16.09)mm on the left and (104.15±14.49)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the M was (0.63 ±0.07)on the left and (0.63 ±0.06)on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);theαwas (55.80±3.64)°on the left and (56.46±4.17)°on the right,there was no statistical difference between two cerebral hemispheres(P>0.05). Conclusion The point at the front side 3/5 of superior temporal sulcus may be the ideal surgical approach entrance point.The distance from the point to temporal horn of lateral ventricle is shortest.It indicates that the approach can reduce the damage of brain tissue.