1Department of Neurological Surgery, University of California, San Francisco, California; and.
2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon.
J Neurosurg. 2019 Mar 1;130(3):822-830. doi: 10.3171/2017.10.JNS172055.
OBJECTIVEMany surgical approaches have been described for lesions within the mesial temporal lobe (MTL), but there are limited reports on the transcortical approach for the resection of tumors within this region. Here, the authors describe the technical considerations and functional outcomes in patients undergoing transcortical resection of gliomas of the MTL.METHODSPatients with a glioma (WHO grades I-IV) located within the MTL who had undergone the transcortical approach in the period between 1998 and 2016 were identified through the University of California, San Francisco (UCSF) tumor registry and were classified according to tumor location: preuncus, uncus, hippocampus/parahippocampus, and various combinations of the former groups. Patient and tumor characteristics and outcomes were determined from operative, radiology, pathology, and other clinical reports that were available through the UCSF electronic medical record.RESULTSFifty patients with low- or high-grade glioma were identified. The mean patient age was 46.8 years, and the mean follow-up was 3 years. Seizures were the presenting symptom in 82% of cases. Schramm types A, C, and D represented 34%, 28%, and 38% of the tumors, and the majority of lesions were located at least in part within the hippocampus/parahippocampus. For preuncus and preuncus/uncus tumors, a transcortical approach through the temporal pole allowed for resection. For most tumors of the uncus and those extending into the hippocampus/parahippocampus, a corticectomy was performed within the middle and/or inferior temporal gyri to approach the lesion. To locate the safest corridor for the corticectomy, language mapping was performed in 96.9% of the left-sided tumor cases, and subcortical motor mapping was performed in 52% of all cases. The mean volumetric extent of resection of low- and high-grade tumors was 89.5% and 96.0%, respectively, and did not differ by tumor location or Schramm type. By 3 months' follow-up, 12 patients (24%) had residual deficits, most of which were visual field deficits. Three patients with left-sided tumors (9.4% of dominant-cortex lesions) experienced word-finding difficulty at 3 months after resection, but 2 of these patients demonstrated complete resolution of symptoms by 1 year.CONCLUSIONSMesial temporal lobe gliomas, including larger Schramm type C and D tumors, can be safely and aggressively resected via a transcortical equatorial approach when used in conjunction with cortical and subcortical mapping.
目的
许多外科手术方法已被用于治疗内侧颞叶（MTL）内的病变，但关于经皮质入路切除该区域内肿瘤的报道有限。在这里，作者描述了接受 MTL 胶质瘤经皮质切除术患者的技术考虑因素和功能结果。
方法
通过加利福尼亚大学旧金山分校（UCSF）肿瘤登记处确定了 1998 年至 2016 年间接受经皮质入路治疗的位于 MTL 内的胶质瘤患者，并根据肿瘤位置进行分类：前弓状束、弓状束、海马/海马旁回以及前组的各种组合。患者和肿瘤特征以及结果是从手术、放射学、病理学和 UCSF 电子病历中可用的其他临床报告中确定的。
结果
确定了 50 例低级别或高级别胶质瘤患者。患者的平均年龄为 46.8 岁，平均随访时间为 3 年。癫痫发作是 82%病例的首发症状。Schramm 型 A、C 和 D 分别代表 34%、28%和 38%的肿瘤，大多数病变至少部分位于海马/海马旁回。对于前弓状束和前弓状束/弓状束肿瘤，经颞极的经皮质入路可进行切除。对于大多数弓状束和延伸至海马/海马旁回的肿瘤，在中颞叶和/或下颞叶内进行皮质切除术以接近病变。为了找到皮质切除术最安全的通道，96.9%的左侧肿瘤病例进行了语言定位，所有病例中有 52%进行了皮质下运动定位。低级别和高级别肿瘤的平均体积切除程度分别为 89.5%和 96.0%，与肿瘤位置或 Schramm 类型无关。在 3 个月的随访中，12 名患者（24%）有残留的缺陷，其中大多数是视野缺陷。3 名左侧肿瘤患者（优势皮质病变的 9.4%）在切除后 3 个月出现找词困难，但其中 2 名患者在 1 年内完全缓解了症状。
结论
当结合皮质和皮质下定位时，经皮质赤道入路可安全且积极地切除包括较大的 Schramm 型 C 和 D 肿瘤在内的内侧颞叶胶质瘤。
