Tag: Mesial temporal lobe

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Surgery for mesial temporal pathology: a 26-year experience

J Neurosurg 143:738–747, 2025

Over 26 years, keyhole craniotomy via the inferior temporal gyrus for mesial temporal lobe surgery showed a low complication rate (5.3%), with only 0.3% permanent neurological deficits. Technique refinement and perioperative strategies minimized risks, supporting this approach as safe and effective for temporal lobe pathology.

A 26-year, single-surgeon study reviewed 717 mesial temporal lobe (MTL) surgeries using a keyhole inferior temporal gyrus (ITG) approach for epilepsy and other pathologies.

• Overall complication rate was low (5.3%), with only 0.3% of patients experiencing permanent neurological deficits and no perioperative deaths.

• Most common complications were hemorrhage (1.5%), postoperative seizure (1.3%), and cosmetic defects (0.6%).

• Neurological complications included transient cranial nerve deficits, visual field deficits, and speech difficulty, all rare.

• No significant correlation found between complications and age, sex, pathology type, operative time, or blood loss.

• Technical strategies such as meticulous closure, careful muscle reapproximation, and limiting brain retraction reduced complications over time.

• The ITG keyhole approach provided safe, effective, and cosmetically favorable access to the MTL, with complication rates improving as technique and teaching matured.

• Long-term follow-up (97% at 36 months) confirmed sustained safety and efficacy of this approach.

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The transcortical equatorial approach for gliomas of the mesial temporal lobe

J Neurosurg 130:822–830, 2019

Many surgical approaches have been described for lesions within the mesial temporal lobe (MTL), but there are limited reports on the transcortical approach for the resection of tumors within this region. Here, the authors describe the technical considerations and functional outcomes in patients undergoing transcortical resection of gliomas of the MTL.

METHODS Patients with a glioma (WHO grades I–IV) located within the MTL who had undergone the transcortical approach in the period between 1998 and 2016 were identified through the University of California, San Francisco (UCSF) tumor registry and were classified according to tumor location: preuncus, uncus, hippocampus/parahippocampus, and various combinations of the former groups. Patient and tumor characteristics and outcomes were determined from operative, radiology, pathology, and other clinical reports that were available through the UCSF electronic medical record.

RESULTS Fifty patients with low- or high-grade glioma were identified. The mean patient age was 46.8 years, and the mean follow-up was 3 years. Seizures were the presenting symptom in 82% of cases. Schramm types A, C, and D represented 34%, 28%, and 38% of the tumors, and the majority of lesions were located at least in part within the hippocampus/ parahippocampus. For preuncus and preuncus/uncus tumors, a transcortical approach through the temporal pole allowed for resection. For most tumors of the uncus and those extending into the hippocampus/parahippocampus, a corticectomy was performed within the middle and/or inferior temporal gyri to approach the lesion. To locate the safest corridor for the corticectomy, language mapping was performed in 96.9% of the left-sided tumor cases, and subcortical motor mapping was performed in 52% of all cases. The mean volumetric extent of resection of low- and high-grade tumors was 89.5% and 96.0%, respectively, and did not differ by tumor location or Schramm type. By 3 months’ followup, 12 patients (24%) had residual deficits, most of which were visual field deficits. Three patients with left-sided tumors (9.4% of dominant-cortex lesions) experienced word-finding difficulty at 3 months after resection, but 2 of these patients demonstrated complete resolution of symptoms by 1 year.

CONCLUSIONS Mesial temporal lobe gliomas, including larger Schramm type C and D tumors, can be safely and aggressively resected via a transcortical equatorial approach when used in conjunction with cortical and subcortical mapping.

 

 

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Statistical shape analysis of temporal lobe in mesial temporal sclerosis patients

Statistical shape analysis of temporal lobe in mesial temporal sclerosis patients

Acta Neurochir (2015) 157:1897–1903

Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy due to hippocampal sclerosis but sometimes deciding this diagnosis can be very difficult. We aim to investigate the shape differences in the temporal lobe of mesial temporal sclerosis epilepsy patients compared with healthy controls, investigating the side difference and, if present, assessing the clinical application of this situation.

Method The MRI scans of mesial TLE patients and controls were retrospectively reviewed. Temporal lobe data were collected from the two-dimensional digital images. Standard anthropometric landmarks were selected and marked on each digital image using TPSDIG 2.04 software. Eight anatomic landmarks were marked on images. A generalized Procrustes analysis was used to evaluate the shape difference. The shape deformation of the temporal lobe from control to patient was evaluated using the TPS method.

Results There were statistically significant TL shape differences between groups. High level deformations for the left and right side from the control to patient group were seen in the TPS graphic. The highest deformation was determined at the inferior lateral temporal midpoint of the middle temporal gyri and superior temporal landmark points of both the right and left sides.

Conclusion Our study for the first time demonstrated temporal shape differences in TLE patients using a landmark-based geometrical morphometric method by taking into consideration the topographic distribution of TL.

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