Endoscopic extradural supraorbital approach to the temporal pole and adjacent area: technical note

The authors’ initial experience with the endoscopic extradural supraorbital approach to the temporal pole and adjacent area is reported. Fully endoscopic surgery using the extradural space via a supraorbital keyhole was performed for tumors in or around the temporal pole, including temporal pole cavernous angioma, sphenoid ridge meningioma, and cavernous sinus pituitary adenoma, mainly using 4-mm, 0° and 30° endoscopes and single-shaft instruments. After making a supraorbital keyhole, a 4-mm, 30° endoscope was advanced into the extradural space of the anterior cranial fossa during lifting of the dura mater. Following identification of the sphenoid ridge, orbital roof, and anterior clinoid process, the bone lateral to the orbital roof was drilled off until the dura mater of the anterior aspect of the temporal lobe was exposed. The dura mater of the temporal lobe was incised and opened, exposing the temporal pole under a 4-mm, 0° endoscope. Tumors in or around the temporal pole were safely removed under a superb view through the extradural corridor. The endoscopic extradural supraorbital approach was technically feasible and safe. The anterior trajectory to the temporal pole using the extradural space under endoscopy provided excellent visibility, allowing minimally invasive surgery. Further surgical experience and development of specialized instruments would promote this approach as an alternative surgical option.

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A Simple Method to Avoid Brain Shift during Neuronavigation: Technical Note

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1716560 ◽

2020 ◽

Author(s):

Jair Leopoldo Raso

Keyword(s):

Dura Mater ◽

Brain Area ◽

Conventional Technique ◽

Technical Note ◽

Cortical Surface ◽

Brain Shift ◽

Simple Method ◽

Cortex Area ◽

Neuronavigation System ◽

The Brain

Abstract Introduction The precise identification of anatomical structures and lesions in the brain is the main objective of neuronavigation systems. Brain shift, displacement of the brain after opening the cisterns and draining cerebrospinal fluid, is one of the limitations of such systems. Objective To describe a simple method to avoid brain shift in craniotomies for subcortical lesions. Method We used the surgical technique hereby described in five patients with subcortical neoplasms. We performed the neuronavigation-guided craniotomies with the conventional technique. After opening the dura and exposing the cortical surface, we placed two or three arachnoid anchoring sutures to the dura mater, close to the edges of the exposed cortical surface. We placed these anchoring sutures under microscopy, using a 6–0 mononylon wire. With this technique, the cortex surface was kept close to the dura mater, minimizing its displacement during the approach to the subcortical lesion. In these five cases we operated, the cortical surface remained close to the dura, anchored by the arachnoid sutures. All the lesions were located with a good correlation between the handpiece tip inserted in the desired brain area and the display on the navigation system. Conclusion Arachnoid anchoring sutures to the dura mater on the edges of the cortex area exposed by craniotomy constitute a simple method to minimize brain displacement (brain-shift) in craniotomies for subcortical injuries, optimizing the use of the neuronavigation system.

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Temporal pole abnormalities detected by 3 T MRI in temporal lobe epilepsy due to hippocampal sclerosis: No influence on seizure outcome after surgery

Seizure ◽

10.1016/j.seizure.2017.04.006 ◽

2017 ◽

Vol 48 ◽

pp. 74-78 ◽

Cited By ~ 4

Author(s):

Sara Casciato ◽

Angelo Picardi ◽

Alfredo D’Aniello ◽

Marco De Risi ◽

Giovanni Grillea ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Seizure Outcome ◽

Temporal Pole

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Falx Cerebelli Meningioma: Technical Note

Romanian Neurosurgery ◽

10.2478/romneu-2014-0046 ◽

2014 ◽

Vol 21 (3) ◽

pp. 337-340

Author(s):

Amit Agrawal

Keyword(s):

Dura Mater ◽

Rare Case ◽

Technical Note ◽

Imaging Findings ◽

Tentorium Cerebelli ◽

History Of

Abstract The falx cerebelli is a small sickle-shaped fold of dura mater below the tentorium cerebelli, which projects forward into the posterior cerebellar notch. We report a rare case of 28 year female presented with the history of headache of six months duration off and it increased in severity and frequency over last 15 days. Imaging findings were suggestive of meningiona arising from the falx cerebelli. The lesion could be excised totally and safely.

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Multiple hippocampal transections for mesial temporal lobe epilepsy

Surgical Neurology International ◽

10.25259/sni_350_2021 ◽

2021 ◽

Vol 12 ◽

pp. 372

Author(s):

David Pitskhelauri ◽

Elina Kudieva ◽

Maria Kamenetskaya ◽

Antonina Kozlova ◽

Pavel Vlasov ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Verbal Memory ◽

Visual Memory ◽

Focal Cortical Dysplasia ◽

Mesial Temporal Lobe Epilepsy ◽

Drug Resistant ◽

Preoperative Level ◽

Temporal Pole ◽

Mesial Temporal Lobe

Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.

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The Benefits of Limited Orbitotomy on the Supraorbital Approach: An Anatomic and Morphometric Study in Virtual Reality

Operative Neurosurgery ◽

10.1093/ons/opz201 ◽

2019 ◽

Vol 18 (5) ◽

pp. 542-550

Author(s):

Alexander X Tai ◽

Kenneth D Sack ◽

Aalap Herur-Raman ◽

Walter C Jean

Keyword(s):

Virtual Reality ◽

Surgical Anatomy ◽

Morphometric Study ◽

Anterior Communicating Artery ◽

Orbital Roof ◽

Supraorbital Approach ◽

Before And After ◽

Anterior Fossa ◽

Tuberculum Sellae ◽

Supraorbital Craniotomy

Abstract BACKGROUND Cadaveric studies on surgical anatomy and approaches are hampered by the limited number of specimens. Virtual reality (VR) technology can overcome this limitation, allowing for more in-depth statistical analysis of the data. OBJECTIVE To determine the benefit of a supraorbital ridge osteotomy in a supraorbital craniotomy targeting (1) the anterior communicating artery complex (ACOM), and (2) a lesion 25 mm above tuberculum sellae, using a large dataset generated by VR. METHODS Computed tomography scans of 30 subjects without cranial osseous pathology were identified for use with VR technology. After correlating VR and DICOM datasets, supraorbital craniotomies were simulated without and with removal of supraorbital ridge, bilaterally (n = 60). Area of freedom (AOF) from the outer table to the targets and the vertical center angle (VCA) to targets were calculated, before and after the orbitotomy. RESULTS For the ACOM, AOF averaged 496 mm2 (range: 322-805) and increased 8.9% to an average of 547 mm2 with the removal of the supraorbital ridge (P < .001). VCA increased from 18.5 to 20.3 degrees. For the suprasellar target, AOF averaged 507 mm2 (range 324-772) and increased 42.5% to 722 mm2 after orbitotomy (P < .001). VCA increased from 22.1 to 30.8 degrees. CONCLUSION VR technology is an emerging tool to study neurosurgical approaches. Here, we demonstrate with VR that the removal of the supraorbital ridge in a supraorbital craniotomy affords greater access to superiorly located lesions of the anterior fossa floor; however, deeper and lower lesions require a more aggressive orbital roof osteotomy to widen the exposure.

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Accelerated long-term forgetting in temporal lobe epilepsy: Evidence of improvement after left temporal pole lobectomy

Epilepsy & Behavior ◽

10.1016/j.yebeh.2011.09.003 ◽

2011 ◽

Vol 22 (4) ◽

pp. 793-795 ◽

Cited By ~ 22

Author(s):

Roberto Gallassi ◽

Luisa Sambati ◽

Roberto Poda ◽

Michelangelo Stanzani Maserati ◽

Federico Oppi ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Temporal Pole

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SUBCORTICAL CONNECTIONS OF THE TEMPORAL POLE IN RELATION TO TEMPORAL LOBE SEIZURES

Archives of Neurology And Psychiatry ◽

10.1001/archneurpsyc.1951.02320120002001 ◽

1951 ◽

Vol 66 (6) ◽

pp. 669 ◽

Cited By ~ 34

Author(s):

C. AJMONE MARSAN

Keyword(s):

Temporal Lobe ◽

Temporal Pole ◽

Temporal Lobe Seizures

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The Transpalpebral Versus the Transciliary Variant of the Supraorbital Keyhole Approach: Anatomic Concepts for Aneurysm Surgery

Operative Neurosurgery ◽

10.1093/ons/opz358 ◽

2019 ◽

Vol 19 (1) ◽

pp. E24-E31

Author(s):

Jonathan Rychen ◽

Daniel W Zumofen ◽

Howard A Riina ◽

Luigi Mariani ◽

Raphael Guzman

Keyword(s):

Potential Role ◽

Skin Incision ◽

Aneurysm Surgery ◽

Orbital Roof ◽

Anterior Aspect ◽

Keyhole Approach ◽

Orbital Rim ◽

Neurovascular Structures ◽

Sphenoid Ridge ◽

Supraorbital Craniotomy

Abstract BACKGROUND The supraorbital craniotomy (SOC) is classically performed through a skin incision in the patient's eyebrow. A variant with a skin incision in the patient's eyelid has become increasingly popular in recent years. OBJECTIVE To compare the transpalpebral and the transciliary variants of the SOC with regard to their potential role in aneurysm surgery. METHODS We carried out cadaveric dissections and virtual craniotomies on computerized tomography datasets. The skin incision, the craniotomy location and size, the working angles, and the achievable exposure of neurovascular structures were assessed and compared for both variants of the SOC. RESULTS The skin incision measured 4 cm for the transpalpebral and 3 cm for the transciliary variant. The skin could be retracted 1.5 cm upward from the lower edge of the orbital rim with the transpalpebral and 2.5 cm upward with the transciliary variant. The craniotomy size was 2.5 × 1.5 cm for both variants, given that the transpalpebral variant included an orbital osteotomy. The bony opening in the transpalpebral variant was 1 cm more caudal; this restricted the craniocaudal working angles and, thereby, limited the achievable exposure of neurovascular structures in the paraclinoid area and along the sphenoid ridge. CONCLUSION If the orbital rim and the anterior aspect of the orbital roof are removed, then the transpalpebral variant of the SOC enables a bony opening that is just as large as that of the transciliary variant. Nonetheless, the more caudal location of the bony opening alters the available working angles and may impede exposure of key structures during aneurysm surgery.

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An Exploratory Study of the Relationship between Face Recognition Memory and the Volume of Medial Temporal Lobe Structures in Healthy Young Males

Behavioural Neurology ◽

10.1155/1998/285061 ◽

1998 ◽

Vol 11 (1) ◽

pp. 3-20 ◽

Cited By ~ 30

Author(s):

Clare E. Mackay ◽

Neil Roberts ◽

Andrew R. Mayes ◽

John J. Downes ◽

Jonathan K. Foster ◽

...

Keyword(s):

Face Recognition ◽

Recognition Memory ◽

Temporal Lobe ◽

Medial Temporal Lobe ◽

Multiple Comparisons ◽

Cerebral Hemispheres ◽

Parahippocampal Gyrus ◽

Bonferroni Correction ◽

Temporal Pole ◽

The Right

A rigorous new methodology was applied to the study of structure function relationships in the living human brain. Face recognition memory (FRM) and other cognitive measures were made in 29 healthy young male subjects (mean age = 21.7 years) and related to volumetric measurements of their cerebral hemispheres and of structures in their medial temporal lobes, obtained using the Cavalieri method in combination with high resolution Magnetic Resonance Imaging (MRI. Greatest proportional variability in volumes was found for the lateral ventricles (57%) for the cerebral hemispheres (8%) in the mean volumes of the hippocampus, parahippocampal gyrus, amygdala, caudate nucleus, temporal pole and temporal lobe on the right and left sides of the brain. The volumes of the right and left parahippocampal gyrus, temporal pole, temporal lobe, and left hippocampus were, prior to application of the Bonferroni correction to take account of 12 multiple comparisons, significantly correlated with the volume of the corresponding hemisphere (p< 0.05). The volumes of all structures were highly correlated (p< 0.0002 for all comparisons) between the two cerebral hemispheres. There were no positive relationships between structure volumes and FRM score. However, the volume of the right amygdala was, prior to application of the Bonferroni correction to take account of 38~multiple comparisons, found to be significantly smaller in the five most consistent high scorers compared to the five most consistent low scorers (t= 2.77,p= 0.025). The implications for possible relationships between healthy medial temporal lobe structures and memory are discussed.

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