Straus David, Byrne Richard W, Sani Sepehr, Serici Anthony, Moftakhar Roham
Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
Surg Neurol Int. 2013 Dec 19;4:159. doi: 10.4103/2152-7806.123285. eCollection 2013.
Various vascular, neoplastic, and epileptogenic pathologies occur in the mediobasal temporal region. A transsylvian translimen insula (TTI) approach can be used as an alternative to temporal transcortical approach to the mediobasal temporal region. The aim of this study was to demonstrate the surgical anatomy of the TTI approach, including the gyral, sulcal, and vascular anatomy in and around the limen insula. The use of this approach is illustrated in the resection of a complex arteriovenous malformation.
The TTI approach to the mediobasal temporal region was performed on three silicone-injected cadaveric heads. The gyral, sulcal, and arterial anatomy of the limen insula was studied in six formalin-fixed injected hemispheres.
The TTI approach provided access to the anterior and middle segments of the mediobasal temporal lobe region as well as allowing access to temporal horn of the lateral ventricle. Using this approach we were able to successfully resect an arteriovenous malformation of the dominant medial temporal lobe.
The TTI approach provides a viable surgical route to the region of mediobasal temporal lobe region. This approach offers an advantage over the temporal transcortical route in that there is less risk of damage to optic radiations and speech area in the dominant hemisphere.
各种血管、肿瘤和致痫性病变发生于中颞叶基底区域。经侧裂经岛阈入路（TTI）可作为颞叶经皮质入路至中颞叶基底区域的替代方法。本研究的目的是展示TTI入路的手术解剖结构，包括岛阈及其周围的脑回、脑沟和血管解剖结构。本文通过切除复杂动静脉畸形来说明该入路的应用。
在三个注入硅胶的尸体头部上实施TTI入路至中颞叶基底区域。在六个经福尔马林固定并注入的大脑半球中研究岛阈的脑回、脑沟和动脉解剖结构。
TTI入路可进入中颞叶基底区域的前部和中部，还可进入侧脑室颞角。通过该入路，我们成功切除了优势侧颞叶内侧的动静脉畸形。
TTI入路为中颞叶基底区域提供了一条可行的手术路径。该入路相对于颞叶经皮质入路的优势在于，对优势半球视辐射和语言区的损伤风险较小。
