Alvaro Campero1, Pablo Ajler2, Lucas Garategui2, Ezequiel Goldschmidt2, Carolina Martins3, Albert Rhoton3. 1. Department of Neurosurgery, Hospital Padilla, Tucumán, Argentina; Department of Neurological Surgery, University of Florida, Gainesville, USA. Electronic address: alvarocampero@yahoo.com.ar. 2. Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 3. Department of Neurological Surgery, University of Florida, Gainesville, USA.
Abstract
OBJECTIVE: To describe the pterional transsylvian-transinsular approach for cavernomas of the left anterior mesiotemporal region in three patients. METHODS: A retrospective analysis of patients who underwent surgery for cavernous angiomas in the temporal lobe was performed via the left mesiotemporal lobe (MTL). The technique was as follows: using the pterional approach, the Sylvian fissure was widely opened, distally to proximally. The temporal branch of the middle cerebral artery was displaced medially, and once the limiting sulcus of the insula was located, an 8mm long corticotomy was performed, just behind the limen insulae. The dissection was extended through the white matter until the anterior portion of the temporal horn was reached. Finally, lesion resection was performed. RESULTS: Three patients presented with cavernomas in the anterior sector of the MTL and underwent the transsylvian-transinsular approach. There were no deaths in this series. One patient sustained a permanent postoperative deficit, a right homonymous quadrantanopia. CONCLUSION: The pterional transsylvian-transinsular approach allows for selective resection of lesions located in the anterior mesiotemporal region (MTR) of the dominant hemisphere, while avoiding damage to the lateral or basal cortex of the temporal lobe or to structures in the dominant hemisphere.
OBJECTIVE: To describe the pterional transsylvian-transinsular approach for cavernomas of the left anterior mesiotemporal region in three patients. METHODS: A retrospective analysis of patients who underwent surgery for cavernous angiomas in the temporal lobe was performed via the left mesiotemporal lobe (MTL). The technique was as follows: using the pterional approach, the Sylvian fissure was widely opened, distally to proximally. The temporal branch of the middle cerebral artery was displaced medially, and once the limiting sulcus of the insula was located, an 8mm long corticotomy was performed, just behind the limen insulae. The dissection was extended through the white matter until the anterior portion of the temporal horn was reached. Finally, lesion resection was performed. RESULTS: Three patients presented with cavernomas in the anterior sector of the MTL and underwent the transsylvian-transinsular approach. There were no deaths in this series. One patient sustained a permanent postoperative deficit, a right homonymous quadrantanopia. CONCLUSION: The pterional transsylvian-transinsular approach allows for selective resection of lesions located in the anterior mesiotemporal region (MTR) of the dominant hemisphere, while avoiding damage to the lateral or basal cortex of the temporal lobe or to structures in the dominant hemisphere.
Authors: Pablo Ajler; Michael Cruz Bravo; Lucas Garategui; Ezequiel Goldschmidt; Gustavo Isolan; Álvaro Campero Journal: Surg Neurol Int Date: 2016-11-21
Authors: Giuseppe Di Perna; Fabio Cofano; Roberto Altieri; Bianca Maria Baldassarre; Luca Bertero; Francesco Zenga; Diego Garbossa Journal: Surg Neurol Int Date: 2020-12-22
Authors: Diego E Shalom; Marcos A Trevisan; Arka Mallela; Maximiliano Nuñez; Ezequiel Goldschmidt Journal: PLoS One Date: 2021-01-07 Impact factor: 3.240