Endoscopic Transanterior Middle Temporal Approach to the Atrium-An Anatomical Feasibility Study

Ruth Lau, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: ruth_lau_rodriguez@hotmail.com.
Roberto Rodriguez Rubio, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Juan Martino, Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla, Santander, Spain.
José L. Sanmillán, Department of Neurological Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Arnau Benet, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Ali Tayebi Meybodi, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Sirin Gandhi, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA; Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Ioannis Kournoutas, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA.
Andreu Gabarrós, Department of Neurological Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.

Document Type

Article

Abstract

OBJECTIVE: The atrium is the most common location for masses in the lateral ventricle. However, access to this area is limited owing to its deep location and adjacent eloquent neurovascular structures, such as the choroidal arteries, perisylvian white matter (WM) tracts, and optic radiations. We investigated the feasibility and safety of an endoscopic approach to the atrium via the anterior middle temporal gyrus (MTG). METHODS: Radiological assessment of a minimally invasive surgical trajectory to the atrium was achieved in 10 patients. Surgical simulation to assess the feasibility of our endoscopic approach was performed on 24 cadaveric specimens using a transzygomatic corridor and temporal craniotomy. Preoperative computed tomography was performed to confirm the surgical trajectory using neuronavigation. Using Klinger's method, 5 hemispheres were dissected to assess the relationship of our approach to the WM tracts. RESULTS: The optimal entry angle to reach the atrium through the anterior MTG was related to the temporal horn in the axial plane and to the Sylvian fissure in the sagittal plane. Our entry point in the anterior MTG was 19 ± 1.92 mm from the temporal pole. The transparenchymal distance to atrium was 24.55 ± 4.3 mm. The WM dissections confirmed that our approach did not violate the optic radiations, uncinate fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, or superior longitudinal fasciculus. CONCLUSION: Our findings have confirmed the feasibility of an anterior endoscopic approach to the atrium through the anterior MTG, with preservation of the functional integrity of the eloquent cortex and WM tracts.

Medical Subject Headings

Cadaver; Diffusion Tensor Imaging; Feasibility Studies; Humans; Lateral Ventricles (surgery); Magnetic Resonance Imaging; Minimally Invasive Surgical Procedures; Neuroendoscopy (methods); Neuronavigation; Temporal Lobe (diagnostic imaging); Tomography, X-Ray Computed; Visual Pathways (diagnostic imaging); White Matter (diagnostic imaging)

Publication Date

8-1-2019

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

128

First Page

e98

Last Page

e106

PubMed ID

30980970

Digital Object Identifier (DOI)

10.1016/j.wneu.2019.04.034

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