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Albert L. Rhoton - One of the best experts on this subject based on the ideXlab platform.
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Cavernomas and Arteriovenous Malformations in the Mesial Temporal Region: Microsurgical Anatomy and Approaches.
Operative neurosurgery (Hagerstown Md.), 2016Co-Authors: Alvaro Campero, Pablo Ajler, Carlos Rica, Albert L. RhotonAbstract:Background The mesial Temporal Region (MTR) is located deep in the Temporal lobe and it is surrounded by important vascular and nervous structures that should be preserved during surgery. Objective To describe microsurgical anatomy and approaches to the MTR in relation to cavernomas and arteriovenous malformations (AVMs). Methods Five formalin-fixed and red silicone-embedded heads of adult cadavers were used for this study. Between January 2003 and June 2014, 7 patients with cavernomas and 6 patients with AVMs in the MTR underwent surgery. Results The MTR of the cadavers was divided into 3 areas: anterior, middle, and posterior. Of the 7 patients with MTR cavernomas, 4 were located anteriorly, 2 were located medially, and 1 was located posteriorly. Of the 6 patients with MTR AVMs, 3 were located in the anterior sector, 2 in the middle sector, and 1 in the posterior sector. For the anterior portion of the MTR, a transsylvian-transinsular approach was used; for the middle portion of the MTR, a transTemporal approach was used (anterior Temporal lobectomy); and for the posterior portion of the MTR, a supracerebellar-transtentorial approach was used. Conclusion Dividing the MTR into 3 Regions allows us to adapt the approach to lesion location. Thus, the anterior sector can be approached via the sylvian fissure, the middle sector can be approached transTemporally, and the posterior sector can be approached via the supracerebellar approach.
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Microvascular anatomy of the medial Temporal Region: part 1: its application to arteriovenous malformation surgery.
Neurosurgery, 2010Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Pablo Rubino, Hung Tzu Wen, Albert L. RhotonAbstract:Background The medial Temporal Region (also called the temporomesial or mediobasal Temporal Region) is the site of the most complex cortical anatomy. Objective To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial Temporal Region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Methods Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. Results The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior Temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. Conclusion An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.
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Microvascular anatomy of the medial Temporal Region: part 1: its application to arteriovenous malformation surgery.
Neurosurgery, 2010Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Hung Tzu Wen, Pablo A Rubino, Albert L. RhotonAbstract:The medial Temporal Region (also called the temporomesial or mediobasal Temporal Region) is the site of the most complex cortical anatomy. To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial Temporal Region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior Temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.
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Microsurgical approaches to the medial Temporal Region: an anatomical study.
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. RhotonAbstract:Objective To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. Methods Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcisternal approach, and two posterior approaches, the occipital interhemispheric and supracerebellar transtentorial approaches. Results The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. Conclusion Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
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Microsurgical approaches to the medial Temporal Region : An anatomical study. Commentary
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. Rhoton, Evandro De Oliveira, João Paulo Mattos, Bernard George, Alexandre CarpenterAbstract:OBJECTIVE: To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. METHODS: Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcistemal approach, and two posterior approaches, the occipital interhemispheric and supracerebeltar transtentorial approaches. RESULTS: The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. CONCLUSION: Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
Juan C. Fernandez-miranda - One of the best experts on this subject based on the ideXlab platform.
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Microvascular anatomy of the medial Temporal Region: part 1: its application to arteriovenous malformation surgery.
Neurosurgery, 2010Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Pablo Rubino, Hung Tzu Wen, Albert L. RhotonAbstract:Background The medial Temporal Region (also called the temporomesial or mediobasal Temporal Region) is the site of the most complex cortical anatomy. Objective To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial Temporal Region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Methods Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. Results The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior Temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. Conclusion An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.
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Microvascular anatomy of the medial Temporal Region: part 1: its application to arteriovenous malformation surgery.
Neurosurgery, 2010Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Hung Tzu Wen, Pablo A Rubino, Albert L. RhotonAbstract:The medial Temporal Region (also called the temporomesial or mediobasal Temporal Region) is the site of the most complex cortical anatomy. To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial Temporal Region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior Temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.
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Microsurgical approaches to the medial Temporal Region: an anatomical study.
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. RhotonAbstract:Objective To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. Methods Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcisternal approach, and two posterior approaches, the occipital interhemispheric and supracerebellar transtentorial approaches. Results The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. Conclusion Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
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Microsurgical approaches to the medial Temporal Region : An anatomical study. Commentary
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. Rhoton, Evandro De Oliveira, João Paulo Mattos, Bernard George, Alexandre CarpenterAbstract:OBJECTIVE: To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. METHODS: Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcistemal approach, and two posterior approaches, the occipital interhemispheric and supracerebeltar transtentorial approaches. RESULTS: The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. CONCLUSION: Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
Mustafa K Başkaya - One of the best experts on this subject based on the ideXlab platform.
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Microsurgical anatomy of the supracerebellar transtentorial approach to the posterior mediobasal Temporal Region: technical considerations with a case illustration.
Neurosurgery, 2008Co-Authors: Roham Moftakhar, Yusuf Izci, Mustafa K BaşkayaAbstract:Surgical access to the posterior portion of the mediobasal Temporal lobe presents a formidable challenge to neurosurgeons, and much controversy still exists regarding the selection of the surgical approach to this Region. The supracerebellar transtentorial (SCTT) approach to the posterior mediobasal Temporal Region can be used as an alternative to the subTemporal or transTemporal approaches. The aim of this study was to demonstrate the surgical anatomy of the SCTT approach and review the gyral, sulcal, and vascular anatomy of the posterior mediobasal Temporal lobe. The use of this approach in the resection of a ganglioglioma located in the left posterior parahippocampal gyrus is illustrated. The SCTT approach to the posterior parahippocampal gyrus was performed on three silicone-injected cadaveric heads. The gyral, sulcal, and arterial anatomy of the posterior mediobasal Temporal lobe was studied in six formalin-fixed injected hemispheres. The SCTT approach provided a direct path to the posterior mediobasal Temporal lobe and exposed the posterior parahippocampal gyrus as well as the adjacent gyri in all of the cadaveric specimens. Through this approach, gross total resection of the ganglioglioma was possible in our patient. The SCTT approach provided a viable surgical route to the posterior mediobasal Temporal lobe in the cadaveric studies. This approach provides an advantage over the subTemporal and transTemporal routes in that there is less Temporal lobe retraction.
Alvaro Campero - One of the best experts on this subject based on the ideXlab platform.
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Cavernomas and Arteriovenous Malformations in the Mesial Temporal Region: Microsurgical Anatomy and Approaches.
Operative neurosurgery (Hagerstown Md.), 2016Co-Authors: Alvaro Campero, Pablo Ajler, Carlos Rica, Albert L. RhotonAbstract:Background The mesial Temporal Region (MTR) is located deep in the Temporal lobe and it is surrounded by important vascular and nervous structures that should be preserved during surgery. Objective To describe microsurgical anatomy and approaches to the MTR in relation to cavernomas and arteriovenous malformations (AVMs). Methods Five formalin-fixed and red silicone-embedded heads of adult cadavers were used for this study. Between January 2003 and June 2014, 7 patients with cavernomas and 6 patients with AVMs in the MTR underwent surgery. Results The MTR of the cadavers was divided into 3 areas: anterior, middle, and posterior. Of the 7 patients with MTR cavernomas, 4 were located anteriorly, 2 were located medially, and 1 was located posteriorly. Of the 6 patients with MTR AVMs, 3 were located in the anterior sector, 2 in the middle sector, and 1 in the posterior sector. For the anterior portion of the MTR, a transsylvian-transinsular approach was used; for the middle portion of the MTR, a transTemporal approach was used (anterior Temporal lobectomy); and for the posterior portion of the MTR, a supracerebellar-transtentorial approach was used. Conclusion Dividing the MTR into 3 Regions allows us to adapt the approach to lesion location. Thus, the anterior sector can be approached via the sylvian fissure, the middle sector can be approached transTemporally, and the posterior sector can be approached via the supracerebellar approach.
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Microsurgical approaches to the medial Temporal Region: an anatomical study.
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. RhotonAbstract:Objective To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. Methods Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcisternal approach, and two posterior approaches, the occipital interhemispheric and supracerebellar transtentorial approaches. Results The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. Conclusion Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
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Microsurgical approaches to the medial Temporal Region : An anatomical study. Commentary
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. Rhoton, Evandro De Oliveira, João Paulo Mattos, Bernard George, Alexandre CarpenterAbstract:OBJECTIVE: To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. METHODS: Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcistemal approach, and two posterior approaches, the occipital interhemispheric and supracerebeltar transtentorial approaches. RESULTS: The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. CONCLUSION: Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
Evandro De Oliveira - One of the best experts on this subject based on the ideXlab platform.
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Microvascular anatomy of the medial Temporal Region: part 1: its application to arteriovenous malformation surgery.
Neurosurgery, 2010Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Pablo Rubino, Hung Tzu Wen, Albert L. RhotonAbstract:Background The medial Temporal Region (also called the temporomesial or mediobasal Temporal Region) is the site of the most complex cortical anatomy. Objective To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial Temporal Region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Methods Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. Results The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior Temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. Conclusion An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.
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Microvascular anatomy of the medial Temporal Region: part 1: its application to arteriovenous malformation surgery.
Neurosurgery, 2010Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Hung Tzu Wen, Pablo A Rubino, Albert L. RhotonAbstract:The medial Temporal Region (also called the temporomesial or mediobasal Temporal Region) is the site of the most complex cortical anatomy. To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial Temporal Region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior Temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.
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Microsurgical approaches to the medial Temporal Region : An anatomical study. Commentary
Neurosurgery, 2006Co-Authors: Alvaro Campero, Gustavo Tróccoli, Carolina Castro Martins, Juan C. Fernandez-miranda, Alexandre Yasuda, Albert L. Rhoton, Evandro De Oliveira, João Paulo Mattos, Bernard George, Alexandre CarpenterAbstract:OBJECTIVE: To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial Temporal Region and to present an anatomic-based classification of the approaches to this area. METHODS: Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial Temporal Region into anterior, middle, and posterior portions. Surgical approaches to the medial Temporal Region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcistemal approach, and two posterior approaches, the occipital interhemispheric and supracerebeltar transtentorial approaches. RESULTS: The anterior portion of the medial Temporal Region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial Temporal Region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial Temporal areas. CONCLUSION: Each approach to medial Temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial Temporal Region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
