scholarly journals Elective inferior temporal lobe resection as an adjunct to subtemporal approach for a case of tentorial meningioma arising from the middle part of the free edge of the tentorium: A case report

2020 ◽  
Vol 11 ◽  
pp. 215
Author(s):  
Sunil Kumar Gupta ◽  
Ashish Aggarwal ◽  
Lomesh Wankhede
Keyword(s):  
Temporal Lobe ◽  
Free Edge ◽  
Middle Part ◽  
Temporal Lobectomy ◽  
Subtemporal Approach ◽  
Working Space ◽  
Tentorial Meningioma ◽  
Temporal Lobe Resection ◽  
Surgical Corridor ◽  
Complete Tumor

Background: Tentorial meningiomas attached to the inner edge of the tentorium are difficult to excise due to their deep location. Sufficient space may not be always available through a subtemporal approach. Thus, the aim of not retracting the brain is not fulfilled. Methods: To gain surgical corridor, we electively resected the inferior temporal lobe. This helped in greater working space, better visualization, and less chances of venous damage. Results: Employing this technique of elective temporal lobe resection helped us in complete tumor removal without compromising on vision or surgical corridor. Conclusion: A limited inferior temporal lobectomy greatly enhances the working space and vision in cases of difficult tentorial meningiomas. This translates into ease of tumor excision without compromising the patient safety.

Subtemporal Approach To The Tentorial Incisura: Normative Morphometric Data Based On Magnetic Resonance Imaging Scans

2006 ◽  
Vol 58 (suppl_1) ◽  
pp. ONS-22-ONS-28 ◽  
Author(s):  
Ardeshir Ardeshiri ◽  
Ardavan Ardeshiri ◽  
Emanuel Wenger ◽  
Markus Holtmannspötter ◽  
Peter A. Winkler
Keyword(s):  
Temporal Lobe ◽  
Middle Cranial Fossa ◽  
Axial Section ◽  
Subtemporal Approach ◽  
Rapid Acquisition ◽  
Coronal Section ◽  
Quadrigeminal Plate ◽  
Surgical Corridor ◽  
Tentorial Incisura ◽  
Tentorial Notch

Abstract OBJECTIVE: The tentorial notch can be contained within a transversal line made in front of the cerebral peduncles and another line through the posterior border of the quadrigeminal plate into the anterior, middle and posterior parts. Different approaches to the tentorial incisura have been established. The subtemporal approach represents one of those options. Since morphometrical analyses of this approach in this region have not yet been performed, the aim of the present study was to measure the surgical corridor along these borders. METHODS: Fifty-three magnetization prepared rapid acquisition gradient echo-sequences of individual brains without pathological lesions were analyzed. For this study, an axial section along the pontomesencephalic sulcus and two coronal sections along the above-described borders were measured using a program specially written by one of the coauthors to obtain various parameters. A triangle circumscribing the surgical corridor was delimited by exactly defined anatomic landmarks for the coronal section, and the depths of the temporal lobe at the incisural borders were measured for the axial section. RESULTS: Various data are given concerning the surgical corridor of a subtemporal approach to the tentorial incisura. The different shapes of this corridor to the incisural region were recorded. According to our measurements, four different types of the temporal lobe could be differentiated. CONCLUSION: Knowledge of these distances and various contours of the path is crucial to avoid brain damage during retraction or manipulation. The curvature of the floor of the middle cranial fossa is highly variable and thus determines the surgical path chosen.

Tailored Temporal Lobectomy for Medically Intractable Epilepsy

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 703-709 ◽  
Author(s):  
Steven M. Falowski ◽  
David Wallace ◽  
Andres Kanner ◽  
Michael Smith ◽  
Michael Rossi ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Class I ◽  
Visual Field Defects ◽  
Seizure Outcome ◽  
Temporal Lobe Resection ◽  
Generalized Epilepsy

Abstract BACKGROUND: There have been only a few large series that have used a tailored temporal lobectomy. OBJECTIVE: To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections. METHODS: Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated. RESULTS: Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections. CONCLUSION: Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.

scholarly journals Is less always better? Keyhole and standard subtemporal approaches: evaluation of temporal lobe retraction and surgical volume with and without zygomatic osteotomy in a cadaveric model

2017 ◽  
Vol 127 (1) ◽  
pp. 157-164 ◽  
Author(s):  
Serdar Ercan ◽  
Alba Scerrati ◽  
Phengfei Wu ◽  
Jun Zhang ◽  
Mario Ammirati
Keyword(s):  
Temporal Lobe ◽  
Zygomatic Arch ◽  
Superior Cerebellar Artery ◽  
Lateral Part ◽  
Surgical Volume ◽  
Middle Fossa ◽  
Anterior Clinoid Process ◽  
Subtemporal Approach ◽  
Fresh Frozen ◽  
Surgical Corridor

OBJECTIVEThe subtemporal approach is one of the surgical routes used to reach the interpeduncular fossa. Keyhole subtemporal approaches and zygomatic arch osteotomy have been proposed in an effort to decrease the amount of temporal lobe retraction. However, the effects of these modified subtemporal approaches on temporal lobe retraction have never been objectively validated.METHODSA keyhole and a classic subtemporal craniotomy were executed in 4 fresh-frozen silicone-injected cadaver heads. The target was defined as the area bordered by the superior cerebellar artery, the anterior clinoid process, supraclinoid internal carotid artery, and the posterior cerebral artery. Once the target was fully visualized, the authors evaluated the amount of temporal lobe retraction by measuring the distance between the base of the middle fossa and the temporal lobe. In addition, the volume of the surgical and anatomical corridors was assessed as well as the surgical maneuverability using navigation and 3D moldings. The same evaluation was conducted after a zygomatic osteotomy was added to the two approaches.RESULTSTemporal lobe retraction was the same in the two approaches evaluated while the surgical corridor and the maneuverability were all greater in the classic subtemporal approach.CONCLUSIONSThe zygomatic arch osteotomy facilitates the maneuverability and the surgical volume in both approaches, but the temporal lobe retraction benefit is confined to the lateral part of the middle fossa skull base and does not result in the retraction necessary to expose the selected target.

scholarly journals Stereotactic EEG-guided radiofrequency thermocoagulation versus anterior temporal lobectomy for mesial temporal lobe epilepsy with hippocampal sclerosis: study protocol for a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yi-He Wang ◽  
Si-Chang Chen ◽  
Peng-Hu Wei ◽  
Kun Yang ◽  
Xiao-Tong Fan ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Controlled Trial ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Radiofrequency Thermocoagulation ◽  
Mesial Temporal Lobe ◽  
Randomised Controlled

Abstract Introduction In this report, we aim to describe the design for the randomised controlled trial of Stereotactic electroencephalogram (EEG)-guided Radiofrequency Thermocoagulation versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (STARTS). Mesial temporal lobe epilepsy (mTLE) is a classical subtype of temporal lobe epilepsy that often requires surgical intervention. Although anterior temporal lobectomy (ATL) remains the most popular treatment for mTLE, accumulating evidence has indicated that ATL can cause tetartanopia and memory impairments. Stereotactic EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a non-invasive alternative associated with lower seizure freedom but greater preservation of neurological function. In the present study, we aim to compare the safety and efficacy of SEEG-guided RF-TC and classical ATL in the treatment of mTLE. Methods and analysis STARTS is a single-centre, two-arm, randomised controlled, parallel-group clinical trial. The study includes patients with typical mTLE over the age of 14 who have drug-resistant seizures for at least 2 years and have been determined via detailed evaluation to be surgical candidates prior to randomisation. The primary outcome measure is the cognitive function at the 1-year follow-up after treatment. Seizure outcomes, visual field abnormalities after surgery, quality of life, ancillary outcomes, and adverse events will also be evaluated at 1-year follow-up as secondary outcomes. Discussion SEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual field protection. This is the first RCT studying cognitive outcomes and treatment results between SEEG-guided RF-TC and standard ATL for mTLE with hippocampal sclerosis. This study may provide higher levels of clinical evidence for the treatment of mTLE. Trial registration ClinicalTrials.gov NCT03941613. Registered on May 8, 2019. The STARTS protocol has been registered on the US National Institutes of Health. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

scholarly journals Does the dural resection bed need to be irradiated? Patterns of recurrence and implications for postoperative radiotherapy for temporal lobe gliomas

2020 ◽  
Author(s):  
Achiraya Teyateeti ◽  
Connie S Geno ◽  
Scott S Stafford ◽  
Anita Mahajan ◽  
Elizabeth S Yan ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Postoperative Radiotherapy ◽  
Progression Free Survival ◽  
High Grade Glioma ◽  
Disease Recurrence ◽  
Temporal Lobectomy ◽  
World Health ◽  
Target Volumes ◽  
Health Organization ◽  
Patterns Of Recurrence

Abstract Background Patterns of recurrence and survival with different surgical and radiotherapy (RT) techniques were evaluated to guide RT target volumes for patients with temporal lobe glioma. Methods and Materials This retrospective cohort study included patients with World Health Organization grades II to IV temporal lobe glioma treated with either partial (PTL) or complete temporal lobectomy (CTL) followed by RT covering both the parenchymal and dural resection bed (whole-cavity radiotherapy [WCRT]) or the parenchymal resection bed only (partial-cavity radiotherapy [PCRT]). Patterns of recurrence, progression-free survival (PFS) and overall survival (OS) were evaluated. Results Fifty-one patients were included and 84.3% of patients had high-grade glioma (HGG). CTL and PTL were performed for 11 (21.6%) and 40 (78.4%) patients, respectively. Median RT dose was 60 Gy (range, 40-76 Gy). There were 82.4% and 17.6% of patients who received WCRT and PCRT, respectively. Median follow-up time was 18.4 months (range, 4-161 months). Forty-six patients (90.2%) experienced disease recurrence, most commonly at the parenchymal resection bed (76.5%). No patients experienced an isolated dural recurrence. The median PFS and OS for the PCRT and WCRT cohorts were 8.6 vs 10.8 months (P = .979) and 19.9 vs 18.6 months (P = .859), respectively. PCRT was associated with a lower RT dose to the brainstem, optic, and ocular structures, hippocampus, and pituitary. Conclusion We identified no isolated dural recurrence and similar PFS and OS regardless of postoperative RT volume, whereas PCRT was associated with dose reduction to critical structures. Omission of dural RT may be considered a reasonable alternative approach. Further validation with larger comparative studies is warranted.

scholarly journals Neuropsychological performance and seizure control after subsequent anteromesial temporal lobe resection following selective amygdalohippocampectomy

Epilepsia ◽  
2016 ◽  
Vol 57 (11) ◽  
pp. 1789-1797 ◽  
Author(s):  
Thomas Sauvigny ◽  
Katja Brückner ◽  
Lasse Dührsen ◽  
Oliver Heese ◽  
Manfred Westphal ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Seizure Control ◽  
Neuropsychological Performance ◽  
Selective Amygdalohippocampectomy ◽  
Temporal Lobe Resection

scholarly journals Pre-Surgical Mood Predicts Memory Decline after Anterior Temporal Lobe Resection for Epilepsy

2011 ◽  
Vol 26 (8) ◽  
pp. 739-745 ◽  
Author(s):  
R. M. Busch ◽  
M. F. Dulay ◽  
K. H. Kim ◽  
J. S. Chapin ◽  
L. Jehi ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Anterior Temporal Lobe ◽  
Memory Decline ◽  
Temporal Lobe Resection

Stereoelectroencephalographic language mapping of the basal temporal cortex predicts postoperative naming outcome

2021 ◽  
pp. 1-11
Author(s):  
Chifaou Abdallah ◽  
Hélène Brissart ◽  
Sophie Colnat-Coulbois ◽  
Ludovic Pierson ◽  
Olivier Aron ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Verbal Fluency ◽  
Temporal Cortex ◽  
Visual Object ◽  
Drug Resistant ◽  
Language Mapping ◽  
Individual Level ◽  
Language Outcome ◽  
Temporal Lobe Resection ◽  
The Individual

OBJECTIVEIn drug-resistant temporal lobe epilepsy (TLE) patients, the authors evaluated early and late outcomes for decline in visual object naming after dominant temporal lobe resection (TLR) according to the resection status of the basal temporal language area (BTLA) identified by cortical stimulation during stereoelectroencephalography (SEEG).METHODSTwenty patients who underwent SEEG for drug-resistant TLE met the inclusion criteria. During language mapping, a site was considered positive when stimulation of two contiguous contacts elicited at least one naming impairment during two remote sessions. After TLR ipsilateral to their BTLA, patients were classified as BTLA+ when at least one positive language site was resected and as BTLA− when all positive language sites were preserved. Outcomes in naming and verbal fluency tests were assessed using pre- and postoperative (means of 7 and 25 months after surgery) scores at the group level and reliable change indices (RCIs) for clinically meaningful changes at the individual level.RESULTSBTLA+ patients (n = 7) had significantly worse naming scores than BTLA− patients (n = 13) within 1 year after surgery but not at the long-term evaluation. No difference in verbal fluency tests was observed. When RCIs were used, 5 of 18 patients (28%) had naming decline within 1 year postoperatively (corresponding to 57% of BTLA+ and 9% of BTLA− patients). A significant correlation was found between BTLA resection and naming decline.CONCLUSIONSBTLA resection is associated with a specific and early naming decline. Even if this decline is transient, naming scores in BTLA+ patients tend to remain lower compared to their baseline. SEEG mapping helps to predict postoperative language outcome after dominant TLR.

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