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Hun Ho Park et al.
of the Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University, South Korea, elaborated the feasibility
of endoscopic transorbital approach to resect intraaxial lesions in the medial temporal lobe through cadaveric dissection combined with clinical cases.
The results were published in the November 2021 issue of the journal
Oper Neurosurg (Hagerstown).
- Excerpted from the article chapter
【Ref: Park HH, et al.
Oper Neurosurg (Hagerstown).
2021 Nov 15; 21(6):E506-E515.
doi: 10.
1093/ons/opab319.
】
Research background
The medial temporal lobe zone is located on the innermost part of the temporal lobe and involves a number of skull base and vascular lesions
.
Although the classic craniotomy approach can remove the lesions of the medial temporal lobe, it requires traction of the temporal lobe and destruction of the lateral neocortex of the temporal lobe
.
Endoscopic transorbital approach (ETOA) has been used as a minimally invasive approach to treat extraaxial lesions in the medial temporal lobe, and in recent years has also been used to resect intraaxial lesions, but only in anatomical studies
.
Hun Ho Park et al.
of the Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University, South Korea, elaborated the feasibility
of endoscopic transorbital approach to resect intraaxial lesions in the medial temporal lobe through cadaveric dissection combined with clinical cases.
The results were published in the November 2021 issue of the journal
Oper Neurosurg (Hagerstown).
Research methods
Then, the clinical data
of 7 patients admitted from September 2018 to April 2020 with endoscopic transorbital approach resection of intraaxial lesions (mainly gliomas) in the medial temporal lobe region were retrospectively analyzed.
The angle of view limit of this approach is shown in Figure 1
.
Figure 1.
Limit angle of endoscopic transorbital approach (shown in green line), MRI horizontal (A) and sagittal (B).
Study results
The results of the study are as follows: 1.
Endoscopic transorbital approach: from the outside to the inside, it is easier to reach the medial temporal lobe area than the endoscopic nasal approach with the path from the inside to the outside (Figure 2).
Figure 2.
Schematic diagram of the endoscopic surgical path via the orbital approach to the medial temporal lobe
.
A-C.
Oblique view A and orthostatic view B showed that the surgical path of the endoscopic transorbital approach was consistent with the long axis (black arrow) of the medial temporal lobe region compared with the endoscopic transnasal approach.
Both approaches protect the optic tract
including the lateral neocortex of the temporal lobe and the Meyer loop (green arrow).
D-H.
Endoscopic access to the medial temporal lobe (black dotted circle) is somewhat difficult
to reach the medial temporal lobe area.
I-M.
The endoscopic outward to inward field of view via the orbital route provides easy access to the medial temporal region (black dotted circle).
2.
Epidural stage: first cut the upper eyelid, then retract the orbit; grinding of orbital parietal wall, sphenoid large and winglets; Cut off the orbital meningeal band (Figure 3).
0° endoscopic dissection
of the orbital approach to the epidural stage of the medial temporal lobe.
A.
Cut the skin
along the upper eyelid crease (red dotted line) towards the lateral canth.
B, C.
Subperiosteal separation of orbicularis oculi muscle and orbital periosteum of lateral orbital wall until supraorbital fissure (SOF) and infraorbital fissure (IOF)
are identified.
D.
Drilling in the bone deep of the temporal muscle until the temporal myofascia is exposed; Enlarges the surgical passage by grinding away bone and reduces traction
on the orbit.
E.
Continue bone grinding until the supraorbital and infraorbital fissures are opened, which are superior and inferior outer boundaries
, respectively.
F, G.
Identify and cut the orbit-meningeal band (MOB).
H.
Exposure, temporal dura, temporal myofascia, sphenoid wings (GWS), and temporal floor
.
3.
Intradural phase: Aspirate the brain tissue medial to the occipital-temporal gyrus until the lateral ventricular temporal angle is opened (Figure 4).
Figure 4.
0° endoscopic dissection
of the intradural stage of the medial temporal lobe region via the orbital approach.
A.
Removal of the dura mater to expose the inferior temporal gyrus (ITG), occipital-temporal gyrus (OTG), and parahippocampal gyrus (PHG)
anterior to the temporal lobe.
Cut the cortex (at the aspirator) along the olfactory sulcus (RS)
on the medial side of the occipital temporal gyrus.
B.
Aspirate the parahippocampal gyrus until the temporal horn of the lateral ventricle is opened, exposing the hippocampus
.
C.
After entering the temporal horn, identify and suction the head, body, and tail of the hippocampus next to the lateral pararidge (CE) of the hippocampus
.
D.
Excision of the hippocampus and parahippocampal gyrus up to the lateral paratriangular triangle (CT) without injury to the lateral geniculate body (LGB) and lateral parabulge
.
E.
Subsippial suction of medial temporal lobe structures
including hooked gyrus.
F-H.
Endoscopic view after resection of the medial temporal lobe, optic tract, cerebral foot, oculomotor nerve, middle cerebral artery (MCA), posterior cerebral artery (PCA), and anterior choroidal artery (AChoA)
are visible extraseptically.
7%)
.
Conclusion of the study
for the removal of intraaxial lesions in the medial temporal lobe.
