De Rosa Andrea, Mosteiro Alejandra, Guizzardi Giulia, Roldán Pedro, Torales Jorge, Matas Fassi Jessica, Cavallo Luigi Maria, Solari Domenico, Prats-Galino Alberto, Di Somma Alberto, Enseñat Joaquim
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
Department of Neurosurgery, Hospital Clinic, Barcelona, Spain.
Front Neuroanat. 2023 Sep 25;17:1282226. doi: 10.3389/fnana.2023.1282226. eCollection 2023.
Starting from an anatomic study describing the possibility of reaching the temporal region through an endoscopic transorbital approach, many clinical reports have now demonstrated the applicability of this strategy when dealing with intra-axial lesions. The study aimed to provide both a qualitative anatomic description of the temporal region, as seen through a transorbital perspective, and a quantitative analysis of the amount of temporal lobe resection achievable via this route.
A total of four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise description of the resection of the temporal lobe through a transorbital perspective is provided. Qualitative anatomical descriptions and quantitative analysis of the amount of the resection were evaluated by means of pre- and post-dissection CT and MRI scans, and three-dimensional reconstructions were made by means of BrainLabSoftware.
The transorbital route gives easy access to the temporal region, without the need for extensive bone removal. The resection of the temporal lobe proceeded in a subpial fashion, mimicking what happens in a surgical scenario. According to our quantitative analysis, the mean volume removed was 51.26%, with the most superior and lateral portion of the temporal lobe being the most difficult to reach.
This anatomic study provides qualitative and quantitative details about the resection of the temporal lobe via an endoscopic transorbital approach. Our results showed that the resection of more than half of the temporal lobe is possible through this surgical corridor. While the anterior, inferior, and mesial portions of the temporal lobe were easily accessible, the most superior and lateral segment was more difficult to reach and resect. Our study serves as an integration to the current anatomic knowledge and clinical practice knowledge highlighting and also as a starting point for further anatomic studies addressing more selected segments of the temporal lobe, i.e., the mesial temporal region.
从一项描述通过内镜经眶入路到达颞区可能性的解剖学研究出发，现在许多临床报告已经证明了该策略在处理轴内病变时的适用性。本研究旨在提供从经眶视角观察到的颞区的定性解剖描述，以及通过该路径可实现的颞叶切除量的定量分析。
在西班牙巴塞罗那大学外科神经解剖学实验室（LSNA）对总共四个尸体头部（八个侧）进行了解剖。提供了从经眶视角对颞叶切除的逐步描述。通过解剖前和解剖后的CT和MRI扫描对切除量进行定性解剖描述和定量分析，并借助BrainLab软件进行三维重建。
经眶路径可轻松到达颞区，无需广泛去除骨质。颞叶切除以软膜下方式进行，模拟手术场景中的情况。根据我们的定量分析，平均切除体积为51.26%，颞叶最上方和外侧部分最难到达。
这项解剖学研究提供了关于通过内镜经眶入路切除颞叶的定性和定量细节。我们的结果表明，通过这条手术通道有可能切除超过一半的颞叶。虽然颞叶的前部、下部和内侧部分易于到达，但最上方和外侧部分更难到达和切除。我们的研究作为对当前解剖学知识和临床实践知识的整合，突出了这一点，同时也作为进一步针对颞叶更特定节段（即内侧颞区）进行解剖学研究的起点。
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