Uribe Juan S, Vale Fernando L
Department of Neurological Surgery, University of South Florida, Tampa, Florida, USA.
J Neurosurg. 2009 Jan;110(1):137-46. doi: 10.3171/2008.4.17508.
In this retrospective review, the authors examine the clinical characteristics, diagnosis, and outcome of surgery in 25 consecutive patients with mesial basal temporal lobe (MBTL) tumors. A limited access approach to the inferior temporal gyrus (ITG) was used.
Patients with MBTL tumors were identified from the epilepsy and tumor surgery database at the authors' institution. Intraaxial tumors localized to the mesial basal structures, and without involvement of the cortical surface of the temporal lobe, temporal stem, and basal ganglia were included. Preoperative and postoperative MR images were obtained in all patients. The mean follow-up period was 24 months (range 9-36 months). Preoperative symptoms, neurological deficits, outcomes, surgical complications, and a technical description of the approach are discussed.
Intraaxial MBTL tumors in 25 patients (mean age 44 years, range 8-76 years) were resected using a limited access approach via the ITG. The largest groups of tumors were high-grade gliomas and dysembryoblastic neuroepithelial tumors (8 in each group), followed by oligodendrogliomas, cerebral metastases, and gangliogliomas. Seizures, headaches, and disorientation were the most common preoperative symptoms. Postoperative MR images demonstrated gross-total resection in all cases. There were 2 surgical complications (a superficial wound infection and a transient frontalis branch palsy). There were no permanent neurological complications or significant new hemianoptic defects.
A limited access ITG approach performed with intraoperative image guidance offers an alternative corridor for resection of MBTL tumors (Schramm Type A). This approach may be technically less demanding than the transsylvian or subtemporal approach. Gross-total resection is feasible utilizing this approach and compares favorably with other, more classical approaches.
在这项回顾性研究中，作者检查了连续25例患有颞叶内侧基底节区（MBTL）肿瘤患者的临床特征、诊断及手术结果。采用了经颞下回（ITG）的有限入路方法。
从作者所在机构的癫痫和肿瘤手术数据库中识别出患有MBTL肿瘤的患者。纳入局限于内侧基底节结构的脑内肿瘤，且未累及颞叶皮质表面、颞叶干和基底节。所有患者均获得术前和术后的磁共振成像（MR）图像。平均随访期为24个月（范围9 - 36个月）。讨论了术前症状、神经功能缺损、手术结果、手术并发症以及该入路的技术描述。
25例患者（平均年龄44岁，范围8 - 76岁）的脑内MBTL肿瘤通过经ITG的有限入路进行了切除。最大的肿瘤组是高级别胶质瘤和胚胎发育不良性神经上皮肿瘤（每组8例），其次是少突胶质细胞瘤、脑转移瘤和神经节胶质瘤。癫痫发作、头痛和定向障碍是最常见的术前症状。术后MR图像显示所有病例均实现了肉眼下全切。有2例手术并发症（1例表浅伤口感染和1例短暂性额支麻痹）。没有永久性神经并发症或明显的新的偏盲缺损。
在术中影像引导下进行的经ITG有限入路为切除MBTL肿瘤（施拉姆A型）提供了另一种途径。该方法在技术上可能比经外侧裂或颞下入路要求更低。利用这种方法实现肉眼下全切是可行的，并且与其他更经典的方法相比具有优势。
