The Supracerebellar-Transtentorial Approach to Vascular Lesions in the Inferomedial Temporal Lobe: 3-Dimensional Operative Video

2017 ◽  
Vol 13 (4) ◽  
pp. 536-536
Author(s):  
Omar Choudhri ◽  
Jason Davies ◽  
Michael T. Lawton
Keyword(s):  
Temporal Lobe ◽  
Vascular Lesions ◽  
3 Dimensional ◽  
Transtentorial Approach

scholarly journals Partial cortico-hippocampectomy in cats, as therapy for refractory temporal epilepsy: A descriptive cadaveric study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244892
Author(s):  
Jessica Zilli ◽  
Monika Kressin ◽  
Anne Schänzer ◽  
Marian Kampschulte ◽  
Martin J. Schmidt
Keyword(s):  
Temporal Lobe ◽  
Tissue Injury ◽  
Histopathological Examination ◽  
Hippocampal Sclerosis ◽  
Intraoperative Complications ◽  
Temporal Cortex ◽  
Cadaveric Study ◽  
Vascular Lesions ◽  
Temporal Epilepsy ◽  
The Brain

Cats, similar to humans, are known to be affected by hippocampal sclerosis (HS), potentially causing antiepileptic drug (AED) resistance. HS can occur as a consequence of chronic seizure activity, trauma, inflammation, or even as a primary disease. In humans, temporal lobe resection is the standardized therapy in patients with refractory temporal lobe epilepsy (TLE). The majority of TLE patients are seizure free after surgery. Therefore, the purpose of this prospective cadaveric study is to establish a surgical technique for hippocampal resection in cats as a treatment for AED resistant seizures. Ten cats of different head morphology were examined. Pre-surgical magnetic resonance imaging (MRI) and computed tomography (CT) studies of the animals’ head were carried out to complete 3D reconstruction of the head, brain, and hippocampus. The resected hippocampal specimens and the brains were histologically examined for tissue injury adjacent to the hippocampus. The feasibility of the procedure, as well as the usability of the removed specimen for histopathological examination, was assessed. Moreover, a micro-CT (mCT) examination of the brain of two additional cats was performed in order to assess temporal vasculature as a reason for possible intraoperative complications. In all cats but one, the resection of the temporal cortex and the hippocampus were successful without any evidence of traumatic or vascular lesions in the surrounding neurovascular structures. In one cat, the presence of mechanical damage (a fissure) of the thalamic surface was evident in the histopathologic examination of the brain post-resection. All hippocampal fields and the dentate gyrus were identified in the majority of the cats via histological examination. The study describes a new surgical approach (partial temporal cortico-hippocampectomy) offering a potential treatment for cats with clinical and diagnostic evidence of temporal epilepsy which do not respond adequately to the medical therapy.

Transtentorial Approach to Parahippocampal Lesions: A Technically Challenging Approach for Preserving Temporal Lobe Structures

2020 ◽  
Vol 142 ◽  
pp. 626-635
Author(s):  
Zoe E. Teton ◽  
Benjamin K. Hendricks ◽  
Dario A. Marotta ◽  
Aaron Cohen-Gadol
Keyword(s):  
Temporal Lobe ◽  
Transtentorial Approach

Left Transsylvian Transcisternal and Transinferior Insular Sulcus Approach for Resection of Uncohippocampal Tumor: 3-Dimensional Operative Video

2018 ◽  
Vol 15 (6) ◽  
pp. E79-E80 ◽  
Author(s):  
Juan C Fernandez-Miranda
Keyword(s):  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Anterior Segment ◽  
Temporal Cortex ◽  
Surgical Anatomy ◽  
Temporal Lobectomy ◽  
Temporal Region ◽  
3 Dimensional ◽  
Selective Amygdalohippocampectomy ◽  
Selective Approach

Abstract The medial temporal lobe can be divided in anterior, middle, and posterior segments. The anterior segment is formed by the uncus and hippocampal head, and it has extra and intraventricular structures. There are 2 main approaches to the uncohippocampal region, the anteromedial temporal lobectomy (Spencer's technique) and the transsylvian selective amygdalohippocampectomy (Yasargil's technique). In this video, we present the case of a 29-yr-old man with new onset of generalized seizures and a contrast-enhancing lesion in the left anterior segment of the medial temporal lobe compatible with high-grade glioma. He had a medical history of cervical astrocytoma at age 8 requiring craniospinal radiation therapy and ventriculoperitoneal shunt placement. The tumor was approached using a combined transsylvian transcisternal and transinferior insular sulcus approach to the extra and intraventricular aspects of the uncohippocampal region. It was resected completely, and the patient was neurologically intact after resection with no further seizures at 6-mo follow-up. The diagnosis was glioblastoma IDH-wild type, for which he underwent adjuvant therapy. Surgical anatomy and technical nuances of this approach are illustrated using a 3-dimensional video and anatomic dissections. The selective approach, when compared to an anteromedial temporal lobectomy, has the advantage of preserving the anterolateral temporal cortex, which is particularly relevant in dominant-hemisphere lesions, and the related fiber tracts, including the inferior fronto-occipital and inferior longitudinal fascicles, and most of the optic radiation fibers. The transsylvian approach, however, is technically and anatomically more challenging and potentially carries a higher risk of vascular injury and vasospasm. Page 1 and figures from Fernández-Miranda JC et al, Microvascular Anatomy of the Medial Temporal Region: Part 1: Its Application to Arteriovenous Malformation Surgery, Operative Neurosurgery, 2010, Volume 67, issue 3, ons237-ons276, by permission of the Congress of Neurological Surgeons (1:26-1:37 in video). Page 1 from Fernández-Miranda JC et al, Three-Dimensio-nal Microsurgical and Tractographic Anatomy of the White Matter of the Human Brain, Neurosurgery, 2008, Volume 62, issue suppl_3, SHC989-SHC1028, by permission of the Congress of Neurological Surgeons (1:54-1:56 in video).

scholarly journals Transtentorial Approach for a Tentorial Meningioma with Superior Extension: 3-Dimensional Operative Video

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ricardo Lourenço Caramanti ◽  
Erica Antunes Effgen ◽  
Raysa Moreira Aprígio ◽  
Dionei Freitas de Moraes ◽  
Carlos Eduardo Rocha ◽  
...  
Keyword(s):  
3 Dimensional ◽  
Tentorial Meningioma ◽  
Transtentorial Approach

scholarly journals 3D DCE-MRA in spinal vascular malformations

2021 ◽  
Author(s):  
Jibin Cao ◽  
Sijia Gao ◽  
Wenge Sun ◽  
Lingling Cui
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
High Sensitivity ◽  
Vascular Lesions ◽  
Arterial Blood Supply ◽  
3 Dimensional ◽  
Spinal Vascular Malformations ◽  
Arterial Blood

Abstract Purpose: This study was carried out to investigate whether 3.0T dynamic enhanced 3 dimensional magnetic resonance angiography (3D DCE-MRA) could identify spinal cord vascular malformations efficiently.Material and Methods: 32 suspected cases of spinal vascular disease with MR imaging and clinical symptoms were detected using DCE-MRA. 28 patients were valued through DSA for 3-5 days, and surgical treatment was performed on 24 patients. Results: DCE-MRA was used to examine all the cases which recognized abnormal vascular lesions clearly, and 28 cases were consistent with DSA or surgical diagnosis. The arterial blood supply was evaluated accurately in 28 cases. The findings were correct in 26 cases.Conclusion: 3.0T DCE-MRA features high sensitivity and accuracy in detecting and characterizing SVMs, especially SDAVF.

scholarly journals The oculomotor-tentorial triangle. Part 1: microsurgical anatomy and techniques to enhance exposure

2019 ◽  
Vol 130 (5) ◽  
pp. 1426-1434 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Sirin Gandhi ◽  
Justin Mascitelli ◽  
Baran Bozkurt ◽  
Gyang Bot ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Posterior Cerebral Artery ◽  
Oculomotor Nerve ◽  
Posterior Circulation ◽  
Vascular Lesions ◽  
Superior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Cavernous Malformations ◽  
Anatomical Features ◽  
Cerebellar Artery

OBJECTIVEAccess to the ventrolateral pontomesencephalic area may be required for resecting cavernous malformations, performing revascularization of the upper posterior circulation, and treating vascular lesions such as aneurysms. However, such access is challenging because of nearby eloquent structures. Commonly used corridors to this surgical area include the optico-carotid, supracarotid, and carotid-oculomotor triangles. However, the window lateral to the oculomotor nerve can also be used and has not been studied. The authors describe the anatomical window formed between the oculomotor nerve and the medial tentorial edge (the oculomotor-tentorial triangle [OTT]) to the ventrolateral pontomesencephalic area, and assess techniques to expand it.METHODSFour cadaveric heads (8 sides) underwent orbitozygomatic craniotomy. The OTT was exposed via a pretemporal approach. The contents of the OTT were determined and their anatomical features were recorded. Also, dimensions of the brainstem surface exposed lateral and inferior to the oculomotor nerve were measured. Measurements were repeated after completing a transcavernous approach (TcA), and after resection of temporal lobe uncus (UnR).RESULTSThe s1 segment and proximal s2 segment of the superior cerebellar artery (SCA) and P2A segment of the posterior cerebral artery (PCA) were the main contents of the OTT, with average exposed lengths of 6.4 ± 1.3 mm and 5.5 ± 1.6 mm for the SCA and PCA, respectively. The exposed length of the SCA increased to 9.6 ± 2.7 mm after TcA (p = 0.002), and reached 11.6 ± 2.4 mm following UnR (p = 0.004). The exposed PCA length increased to 6.2 ± 1.6 mm after TcA (p = 0.04), and reached 10.4 ± 1.8 mm following UnR (p < 0.001). The brainstem surface was exposed 7.1 ± 0.5 mm inferior and 5.6 ± 0.9 mm lateral to the oculomotor nerve initially. The exposure inferior to the oculomotor nerve increased to 9.3 ± 1.7 mm after TcA (p = 0.003), and to 9.9 ± 2.5 mm after UnR (p = 0.21). The exposure lateral to the oculomotor nerve increased to 8.0 ± 1.7 mm after TcA (p = 0.001), and to 10.4 ± 2.4 mm after UnR (p = 0.002).CONCLUSIONSThe OTT is an anatomical window that provides generous access to the upper ventrolateral pontomesencephalic area, s1- and s2-SCA, and P2A-PCA. This window may be efficiently used to address various pathologies in the region and is considerably expandable by TcA and/or UnR.

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 Psychopathological peculiarities of vascular dementia with different localization of pathological focuses

2020 ◽  
Keyword(s):  
Vascular Dementia ◽  
Brain Damage ◽  
Temporal Lobe ◽  
Parietal Lobe ◽  
Neuropsychiatric Symptoms ◽  
Low Frequency ◽  
Occipital Lobe ◽  
Vascular Lesions ◽  
Early Application ◽  
Wide Range

Relevance. Vascular dementia, caused by various organic lesions, volume and location of organic damage to brain tissue, manifests itself in a wide range of concomitant neuropsychiatric symptoms. However, despite the obvious link between the location of vascular lesions and the patient's psychopathological symptoms, the effects of the physical characteristics of the brain damage that caused the vascular dementia and the corresponding neuropsychiatric symptoms remain poorly understood. The aim of the study was to investigate psychopathological features of cognitive impairment in patients with vascular dementia depending on the location of the lesion. Contingents and methods. 157 people with a diagnosis of vascular dementia were examined, divided into five groups: group 1 — 22 people with localization of the pathological process in the frontal lobe; group 2 — 18 patients with temporal lobe lesions; group 3 — 17 patients with parietal lobe lesions; group 4 — 15 patients with occipital lobe lesions and group 5 — 68 people with total lesions. Results: It was found that the lesion of the frontal lobes is characterized by a high frequency of euphoria and hallucinatory phenomena, as well as minor manifestations of apathy and anxiety; lesion of the temporal lobe — the highest frequency and severity of apathy; parietal lesions — low frequency of anxiety combined with its high intensity; occipital lesions — intense depressive experiences (in cases where they occurred), total brain damage — the lowest prevalence and intensity of delusional feelings, irritability and agitation. Conclusions. A comprehensive study of patients with vascular dementia identified specific to each localization of brain lesions spectra of neuropsychiatric symptoms, which creates the necessary conditions for early application of differentiated therapeutic and rehabilitation measures and, accordingly, to improve the quality of patients life in this category.

Microsurgical Anatomy of the Optic Radiation and Related Fibers in 3-Dimensional Images

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. ons160-ons172 ◽  
Author(s):  
Richard Gonzalo Párraga ◽  
Guilherme Carvalhal Ribas ◽  
Leonardo Christiaan Welling ◽  
Raphael Vicente Alves ◽  
Evandro de Oliveira
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Lateral Geniculate Body ◽  
Microsurgical Anatomy ◽  
Optic Radiation ◽  
3 Dimensional ◽  
Important Relationship ◽  
Fiber Dissection ◽  
The Mean ◽  
Dissection Technique

Abstract BACKGROUND: The fiber dissection technique provides unique 3-dimensional anatomic knowledge of the white matter. OBJECTIVE: To examine the optic radiation anatomy and its important relationship with the temporal stem and to discuss its findings in relation to the approaches to temporal lobe lesions. METHODS: We studied 40 cerebral hemispheres of 20 brains that had been fixed in formalin solution for 40 days. After removal of the arachnoid membrane, the hemispheres were frozen, and the Klingler technique was used for dissection under magnification. Stereoscopic 3-dimensional images of the dissection were obtained for illustration. RESULTS: The optic radiations are located deep within the superior and middle temporal gyri, always above the inferior temporal sulcus. The mean distance between the cortical surface and the lateral edge of the optic radiation was 21 mm. Its fibers are divided into 3 bundles after their origin. The mean distance between the anterior tip of the temporal horn and the Meyer loop was 4.5 mm, between the temporal pole and the anterior border of the Meyer loop was 28.4 mm, and between the limen insulae and the Meyer loop was 10.7 mm. The mean distance between the lateral geniculate body and the lateral margin of the central bundle of the optic radiation was 17.4 mm. CONCLUSION: The white matter fiber dissection reveals the tridimensional intrinsic architecture of the brain, and its knowledge regarding the temporal lobe is particularly important for the neurosurgeon, mostly because of the complexity of the optic radiation and related fibers.

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.

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