Surgical Approaches to the Temporal Horn: An Anatomic Analysis of White Matter Tract Interruption

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art_KADRI_Surgical_Approaches_to_the_Temporal_Horn_An_Anatomic_2017.PDF (2.4 MB)
Citações na Scopus
14
Tipo de produção
article
Data de publicação
2017
DOI
Scopus
Web of Science
Título da Revista
ISSN da Revista
Título do Volume
Editora
OXFORD UNIV PRESS INC
Autores
OLIVEIRA, Jean G. de
KRAYENBUHL, Niklaus
TURE, Ugur
OLIVEIRA, Evandro P. L. de
AL-MEFTY, Ossama
Citação
OPERATIVE NEUROSURGERY, v.13, n.2, p.258-270, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
BACKGROUND: Surgical access to the temporal horn is necessary to treat tumors and vascular lesions, but is used mainly in patients with mediobasal temporal epilepsy. The surgical approaches to this cavity fall into 3 primary categories: lateral, inferior, and transsylvian. The current neurosurgical literature has underestimated the interruption of involved fiber bundles and the correlated clinical manifestations. OBJECTIVE: To delineate the interruption of fiber bundles during the different approaches to the temporal horn. METHODS: We simulated the lateral (trans-middle temporal gyrus), inferior (transparahippocampal gyrus), and transsylvian approaches in 20 previously frozen, formalin-fixed human brains (40 hemispheres). Fiber dissection was then done along the lateral and inferior aspects under the operating microscope. Each stage of dissection and its respective fiber tract interruption were defined. RESULTS: The lateral (trans-middle temporal gyrus) approach interrupted ""U"" fibers, the superior longitudinal fasciculus (inferior arm), occipitofrontal fasciculus (ventral segment), uncinate fasciculus (dorsolateral segment), anterior commissure (posterior segment), temporopontine, inferior thalamic peduncle (posterior fibers), posterior thalamic peduncle (anterior portion), and tapetum fibers. The inferior (transparahippocampal gyrus) approach interrupted ""U"" fibers, the cingulum (inferior arm), and fimbria, and transected the hippocampal formation. The transsylvian approach interrupted ""U"" fibers (anterobasal region of the extreme capsule), the uncinate fasciculus (ventromedial segment), and anterior commissure (anterior segment), and transected the anterosuperior aspect of the amygdala. CONCLUSION: White matter dissection improves our knowledge of the complex anatomy surrounding the temporal horn. Identifying the fiber bundles at risk during each surgical approach adds important information for choosing the appropriate surgical strategy.
Palavras-chave
Neuroanatomy, Approach, Neurosurgery, Temporal horn, Tracts, Whitematter, Epilepsy, Temporal lobe surgery, Temporal lobe, Surgical procedures
URI
https://observatorio.fm.usp.br/handle/OPI/21585
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Coleções
Artigos e Materiais de Revistas Científicas - LIM/02