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首页> 外文期刊>Neurosurgery >A combined subtemporal and transventricular/transchoroidal fissure approach to medial temporal lesions.
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A combined subtemporal and transventricular/transchoroidal fissure approach to medial temporal lesions.

机译：颞下和经心室/经脉络膜裂的联合方法治疗内侧颞部病变。

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OBJECTIVE: To minimize therapeutic morbidity such as cognitive function disturbance and vascular injury to perforating arteries, preoperative functional mapping of the basal temporal lobe functions was performed and the medial temporal lesions were resected via a combined subtemporal and transventricular/transchoroidal fissure approach. METHODS: Twenty-one patients with medial temporal lesions including tumors, arteriovenous malformations, and medial temporal lobe epilepsy underwent operation. The neurovascular structures in the ambient cistern were first dissected free from the medial temporal lobe with a conventional subtemporal approach. Then, the temporal horn was opened through the basal surface of the temporal lobe. Finally, the ambient cistern was accessed from the temporal horn through the choroidal fissure. In five patients whose lesions were revealed to be located on the dominant side by preoperative intracarotid amytal administration test (Wada test), functional mapping of the basal temporallobe language cortex was monitored for 1 week by use of a subdural electrocorticogram grid before the extirpation surgery. The entrance point from the temporal base to the temporal horn was determined by the result of the functional mapping. RESULTS: The lesions were resected safely and completely in all cases. Language and cognitive functions were preserved even in patients with the basal language area on the dominant side. CONCLUSION: Surgeons can confirm the important neurovascular structures from the subtemporal route and from the transtemporal horn route by a combined subtemporal and transventricular/transchoroidal fissure approach. This approach is especially effective for avoiding ischemic complications by allowing direct confirmation of the anterior choroidal and thalamoperforating arteries.
机译：目的：为了使诸如认知功能障碍和穿孔动脉血管损伤等治疗并发症最小化，术前对基底颞叶功能进行了功能标测，并通过颞下和心室/经脉络膜裂隙联合切除了颞内侧病变。方法：21例颞内侧病变，包括肿瘤，动静脉畸形和内侧颞叶癫痫患者接受手术治疗。首先用常规的颞下方法从周围颞叶切开周围水箱中的神经血管结构。然后，颞角穿过颞叶的基底表面张开。最后，从颞角通过脉络膜裂隙进入环境水箱。在5例术前通过颈动脉内淀粉样变性给药试验（Wada试验）发现病变位于优势侧的患者中，在摘除手术前使用硬膜下皮质脑电图监测基底颞叶语言皮层的功能图监测1周。从颞基到颞角的入口点由功能映射的结果确定。结果：所有病例均安全，完整地切除了病灶。即使在基础语言区域占优势的患者中也保留了语言和认知功能。结论：外科医生可以通过颞下和脑室/经脉络膜裂隙的联合方法确认颞下途径和颞下角途径的重要神经血管结构。通过直接确认前脉络膜和丘脑穿孔的动脉，这种方法对于避免缺血性并发症特别有效。

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