Abstract
Background:Various vascular, neoplastic, and epileptogenic pathologies occur in the mediobasal temporal region. A transsylvian translimen insula (TTI) approach can be used as an alternative to temporal transcortical approach to the mediobasal temporal region. The aim of this study was to demonstrate the surgical anatomy of the TTI approach, including the gyral, sulcal, and vascular anatomy in and around the limen insula. The use of this approach is illustrated in the resection of a complex arteriovenous malformation.Methods:The TTI approach to the mediobasal temporal region was performed on three silicone-injected cadaveric heads. The gyral, sulcal, and arterial anatomy of the limen insula was studied in six formalin-fixed injected hemispheres.Results:The TTI approach provided access to the anterior and middle segments of the mediobasal temporal lobe region as well as allowing access to temporal horn of the lateral ventricle. Using this approach we were able to successfully resect an arteriovenous malformation of the dominant medial temporal lobe.Conclusion:The TTI approach provides a viable surgical route to the region of mediobasal temporal lobe region. This approach offers an advantage over the temporal transcortical route in that there is less risk of damage to optic radiations and speech area in the dominant hemisphere.
Highlights
Various vascular, neoplastic, and epileptogenic pathologies occur in the mediobasal temporal region
De Oliveira[4] divided the mediobasal temporal lobe into three regions in an anterior‐posterior plane: the anterior segment extending from the rhinal sulcus to the choroidal point; the middle segment extending from the choroidal point to the posterior aspect of the quadrigeminal plate; and the posterior segment consisting of the mediobasal
Superior approach to the mediobasal temporal lobe consists of the transsylvian‐transinsular approach, first described by Yasargil for selective amygdalohippocampectomy.[38]
Summary
The aim of this study was to demonstrate the surgical anatomy of the TTI approach, including the gyral, sulcal, and vascular anatomy in and around the limen insula
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