scholarly journals Endoscope-assisted supracerebellar transtentorial approach to the posterior medial temporal lobe for resection of cavernous malformation

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
M. Yashar S. Kalani ◽  
Ting Lei ◽  
Nikolay L. Martirosyan ◽  
Mark E. Oppenlander ◽  
Robert F. Spetzler ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Cavernous Malformation ◽  
Patient Positioning ◽  
Anterolateral Approach ◽  
Subtemporal Approach ◽  
Vein Of Labbé ◽  
Mesial Temporal Lobe ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The mesial temporal lobe can be approached via a pterional or orbitozygomatic craniotomy, the subtemporal approach, or transcortically. Alternatively, the entire mesial temporal lobe can be accessed using a lateral supracerebellar transtentorial (SCTT) approach. Here we describe the technical nuances of patient positioning, craniotomy, supracerebellar dissection, and tentorial disconnection to traverse the tentorial incisura to arrive at the posterior mesial temporal lobe for a cavernous malformation. The SCTT approach is especially useful for lesions in the dominant temporal lobe where an anterolateral approach may endanger language centers or the vein of Labbé.The video can be found here: https://youtu.be/D8mIR5yeiVw.

scholarly journals Supracerebellar transtentorial approach to the tentorial incisura and beyond

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Kyle I. Swanson ◽  
Ulas Cikla ◽  
Kutluay Uluc ◽  
Mustafa K. Baskaya
Keyword(s):  
Temporal Lobe ◽  
Cavernous Malformation ◽  
Link Type ◽  
Suboccipital Craniotomy ◽  
Tentorial Meningioma ◽  
Eloquent Cortex ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The supracerebellar transtentorial approach via a suboccipital craniotomy provides a corridor to reach lesions of the tentorial incisura and supratentorial lesions of the posterior medial basal temporal lobe, such as lesions of the posterior parahippocampal and fusiform gyri. The supracerebellar transtentorial approach obviates the need for either retraction of eloquent cortex or a transcortical route to reach lesions in this region. We present three cases that demonstrate the utility of this approach: a left-sided tentorial meningioma with superior projection, a left-sided posterior parahippocampal cavernous malformation, and a left-sided posterior parahippocampal grade 2 oligodendroglioma.The video can be found here: https://youtu.be/OLnzUGZfUqk.

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.

scholarly journals Supracerebellar Transtentorial Approach for Mesial Temporal Lobe Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E236-E236 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Stereotactic Navigation ◽  
Mesial Temporal Lobe ◽  
Transtentorial Approach

Abstract Medial temporal cavernous malformations can involve transgression of eloquent parenchyma. For a tentorium-abutting temporal cavernous malformation, the supracerebellar transtentorial corridor is a suitable approach with minimal parenchymal insult. Using dynamic and gravity retraction, lighted bipolar forceps and suction, and stereotactic navigation, this trajectory provides a minimally invasive corridor. The patient in this case has a medial temporal cavernous malformation, with the lesion abutting the tentorial leaflet. The cavernous malformation is accessed and removed in a piecemeal manner. Complete removal of the lesion is achieved. The patient remained neurologically stable after the procedure. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy

2019 ◽  
Vol 18 (6) ◽  
pp. 684-691 ◽  
Author(s):  
Yuhao Huang ◽  
Steven A Leung ◽  
Jonathon J Parker ◽  
Allen L Ho ◽  
Max Wintermark ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cranial Nerve ◽  
Medial Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Parahippocampal Gyrus ◽  
Preoperative Imaging ◽  
Retrospective Assessment ◽  
Chi Squared ◽  
Mesial Temporal Lobe

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) is a minimally invasive therapy for treating medication-resistant mesial temporal lobe epilepsy. Cranial nerve (CN) palsy has been reported as a procedural complication, but the mechanism of this complication is not understood. OBJECTIVE To identify the cause of postoperative CN palsy after LITT. METHODS Four medial temporal lobe epilepsy patients with CN palsy after LITT were identified for comparison with 22 consecutive patients with no palsy. We evaluated individual variation in the distance between CN III and the uncus, and CN IV and the parahippocampal gyrus using preoperative T1- and T2-weighted magnetic resonance (MR) images. Intraoperative MR thermometry was used to estimate temperature changes. RESULTS CN III (n = 2) and CN IV palsies (n = 2) were reported. On preoperative imaging, the majority of identified CN III (54%) and CN IV (43%) were located within 1 to 2 mm of the uncus and parahippocampal gyrus tissue border, respectively. Affected CN III and CN IV were more likely to be found < 1 mm of the tissue border (PCNIII = .03, PCNIV < .01; chi-squared test). Retrospective assessment of thermal profile during ablation showed higher temperature rise along the mesial temporal lobe tissue border in affected CNs than unaffected CNs after controlling for distance (12.9°C vs 5.8°C; P = .03; 2-sample t-test). CONCLUSION CN palsy after LITT likely results from direct heating of the respective CN running at extreme proximity to the mesial temporal lobe. Low-temperature thresholds set at the border of the mesial temporal lobe in patients whose CNs are at close proximity may reduce this risk.

Neuropsychological outcome after subtemporal versus transsylvian approach for selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy: a randomised prospective clinical trial

2017 ◽  
Vol 89 (10) ◽  
pp. 1057-1063 ◽  
Author(s):  
Viola Lara Vogt ◽  
Daniel Delev ◽  
Alexander Grote ◽  
Johannes Schramm ◽  
Marec von Lehe ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Learning ◽  
Mesial Temporal Lobe Epilepsy ◽  
Neuropsychological Outcome ◽  
Semantic Fluency ◽  
Subtemporal Approach ◽  
Selective Amygdalohippocampectomy ◽  
Mesial Temporal Lobe ◽  
Post Hoc

ObjectiveTo compare the effects of different surgical approaches for selective amygdalohippocampectomy in patients with pharmacoresistant mesial temporal lobe epilepsy with regard to the neuropsychological outcome and to replicate an earlier study employing a matched-pair design.Method47 patients were randomised to subtemporal versus transsylvian approaches. Memory, language, attentional and executive functions were assessed before and 1 year after surgery. Multivariate analyses of variance (MANOVAs) with presurgical and postsurgical assessments as within-subject variables and approach and side of surgery as between-subject factors were calculated. Additionally, the frequencies of individual performance changes based on reliable change indices were analysed.ResultsSeizure freedom International League Against Epilepsy (ILAE) 1a, was achieved in 62% of all patients without group difference. MANOVAs revealed no significant effects of approach on cognition. Tested separately for each parameter, verbal recognition memory declined irrespective of approach. Post hoc tests revealed that on group level, the subtemporal approach was associated with a worse outcome for verbal learning and delayed free recall as well as for semantic fluency. Accordingly, on individual level, more patients in the subtemporal group declined in verbal learning. Left side of surgery was associated with decline in naming regardless of approach.ConclusionThe main analysis did not confirm the effects of approach on memory outcome seen in our previous study. Post hoc testing, however, showed greater memory losses with the subtemporal approach. Previous findings were replicated for semantic fluency. The discrepant results are discussed on the background of the different study designs.

Children show adult-like hippocampal pattern separation for familiar but not novel events

2020 ◽  
Author(s):  
Susan L. Benear ◽  
Elizabeth A. Horwath ◽  
Emily Cowan ◽  
M. Catalina Camacho ◽  
Chi Ngo ◽  
...  
Keyword(s):  
Episodic Memory ◽  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Developmental Change ◽  
Pattern Separation ◽  
Developmental Changes ◽  
Similarity Analysis ◽  
Separation Processes ◽  
Parahippocampal Cortex ◽  
Pattern Similarity

The medial temporal lobe (MTL) undergoes critical developmental change throughout childhood, which aligns with developmental changes in episodic memory. We used representational similarity analysis to compare neural pattern similarity for children and adults in hippocampus and parahippocampal cortex during naturalistic viewing of clips from the same movie or different movies. Some movies were more familiar to participants than others. Neural pattern similarity was generally lower for clips from the same movie, indicating that related content taxes pattern separation-like processes. However, children showed this effect only for movies with which they were familiar, whereas adults showed the effect consistently. These data suggest that children need more exposures to stimuli in order to show mature pattern separation processes.

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