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Supracerebellar transtentorial approach-resection of the tentorium instead of an opening-to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications: clinical article.

Abstract

OBJECT
The aim of this study was to describe the surgical anatomy of the mediobasal aspect of the temporal lobe and the supracerebellar transtentorial (SCTT) approach performed not with an opening, but with the resection of the tentorium, as an alternative route for the neurosurgical management of vascular and tumoral lesions arising from this region.
METHODS
Cadaveric specimens were used to illustrate the surgical anatomy of the mediobasal region of the temporal lobe. Demographic aspects, characteristics of lesions, clinical presentation, surgical results, follow-up findings, and outcomes were retrospectively reviewed for patients referred to receive the SCTT approach with tentorial resection.
RESULTS
Ten patients (83%) were female and 2 (17%) were male. Their ages ranged from 6 to 59 years (mean 34.5 ± 15.8 years). All lesions (3 posterior cerebral artery aneurysms, 3 arteriovenous malformations, 3 cavernous malformations, and 3 tumors) were completely excluded or resected. After a mean follow-up period of 143 months (range 10-240 months), the mean postoperative Glasgow Outcome Scale score was 4.9.
CONCLUSIONS
Knowledge of the surgical anatomy provides improvement for microsurgical approaches. The evolution from a small opening to a resection of the tentorium absolutely changed the exposure of the mediobasal aspect of the temporal lobe. The SCTT approach with tentorial resection is an excellent alternative route to the posterior part of mediobasal aspect of the temporal lobe, and it was enough to achieve the best neurosurgical management of tumoral and vascular lesions located in this area.

Links

  • Publisher Full Text

    • Authors

    de Oliveira JG, Párraga RG, Chaddad-Neto F, Ribas GC, de Oliveira EP

    Institution

    Institute of Neurological Sciences, Hospital Beneficência Portuguesa de São Paulo, Brazil.

    Source

    Journal of neurosurgery 116:4 2012 Apr pg 764-72

    MeSH

    Adolescent
    Adult
    Brain Neoplasms
    Cavernous Sinus
    Child
    Craniotomy
    Dura Mater
    Female
    Follow-Up Studies
    Humans
    Intracranial Aneurysm
    Intracranial Arteriovenous Malformations
    Male
    Microsurgery
    Middle Aged
    Postoperative Complications
    Retrospective Studies
    Sella Turcica
    Temporal Lobe
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22242666