Choi Jeong-Wook, Jung Shin, Jung Tae-Young, Jang Woo-Youl, Moon Kyung-Sub, Kim In-Young
Department of Neurosurgery, Chonnam National University Hwasun Hospital & Chonnam Medical School, the Brain Korea 21 Project, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
J Korean Neurosurg Soc. 2011 Dec;50(6):538-41. doi: 10.3340/jkns.2011.50.6.538. Epub 2011 Dec 31.
We evaluated a modified trans-middle temporal gyrus (MTG) approach with good postoperative visual preservation for patients with trigonal tumors.
Three patients with a trigonal tumor were treated via the modified trans-MTG approach guided by a neuro-navigator. Modified trans-MTG approach involve the incision at the MTG within 5 mm to the superior temporal sulcus. This approach makes a proper trajectory to the trigone but also reduces the retraction injury of MTG as little as possible to prevent postoperative visual field defect. Preoperative and postoperative visual field examination using perimetry was performed to evaluate the visual field.
Three patients underwent surgery for lymphoma in the right trigone, meningioma in the left trigone, and focal enhancing nodule in the right paratrigonal area, respectively. In case of lymphoma, preoperative examination showed a left homonymous hemianopsia : one week later after surgery, a visual field examination was performed and revealed improvement of the visual field defect. In case of the meningioma, the preoperative examination showed no visual field defect : one month later, the visual field had no defect. In case of the enhancing nodule, preoperative visual field testing revealed a partial left homonymous hemianopsia. Visual examination within one month after surgery showed no visual field defect. All three patients treated with the modified trans-MTG approach showed no visual deterioration after surgery.
The modified trans-MTG approach provides a safe and useful technique for trigonal tumors without postoperative visual field deterioration and affords adequate exposure of the trigonal tumor with a short trajectory.
我们评估了一种改良的经颞中回（MTG）入路，该入路可使三角区肿瘤患者术后视力良好保留。
3例三角区肿瘤患者在神经导航引导下采用改良经MTG入路进行治疗。改良经MTG入路包括在距颞上沟5mm以内的MTG处做切口。该入路可形成通向三角区的合适路径，同时尽可能减少MTG的牵拉损伤，以预防术后视野缺损。采用视野计进行术前和术后视野检查以评估视野情况。
3例患者分别接受了右侧三角区淋巴瘤、左侧三角区脑膜瘤和右侧三角旁区局灶性强化结节的手术。淋巴瘤患者术前检查显示左侧同向性偏盲：术后1周进行视野检查，结果显示视野缺损有所改善。脑膜瘤患者术前检查未显示视野缺损：术后1个月，视野无缺损。强化结节患者术前视野检查显示部分左侧同向性偏盲。术后1个月内的视野检查显示无视野缺损。所有采用改良经MTG入路治疗的3例患者术后均未出现视力恶化。
改良经MTG入路为三角区肿瘤提供了一种安全有效的技术，术后无视野恶化，且通过较短路径可充分暴露三角区肿瘤。
