"Tangential" resection of medial temporal lobe arteriovenous malformations with the orbitozygomatic approach

Document Type

Article

Abstract

OBJECTIVE: Arteriovenous malformations (AVMs) of the medial temporal lobe are usually resected through subtemporal-transcortical approaches that provide a trajectory that is perpendicular to the plane of the AVM. The pterional approach is sometimes used for AVMs in the uncus and amygdala, but it is not recommended for AVMs in the hippocampal region because it provides a "tangential" approach with limited access to posterior feeding arteries and draining veins. The orbitozygomatic approach enhances exposure along this tangential trajectory and was used in a consecutive series of 10 patients to determine its advantages. METHODS: During a 5.7-year period, 43 patients underwent resection of temporal lobe AVMs, 10 of which were located in the medial temporal lobe (amygdala and uncus [Region A] or hippocampus, parahippocampus, and fusiform gyrus [Region B]). AVMs were evenly distributed by region and by hemispheric dominance and included two Spetzler-Martin Grade IV lesions. An orbitozygomatic approach was used in all cases. RESULTS: Complete resection was accomplished in nine patients, and one patient underwent multimodality management with postoperative stereotactic radiosurgery. Good outcomes (Rankin outcome score

Medical Subject Headings

Adolescent; Adult; Amygdala (blood supply, surgery); Cerebral Angiography; Child; Combined Modality Therapy; Craniotomy (methods); Dominance, Cerebral (physiology); Female; Follow-Up Studies; Hippocampus (blood supply, surgery); Humans; Intracranial Arteriovenous Malformations (surgery); Magnetic Resonance Angiography; Male; Middle Aged; Neurologic Examination; Orbit (surgery); Parahippocampal Gyrus (blood supply, surgery); Radiosurgery; Temporal Lobe (blood supply); Treatment Outcome; Zygoma (surgery)

Publication Date

3-19-2004

Publication Title

Neurosurgery

ISSN

0148-396X

Volume

54

Issue

3

First Page

645

Last Page

51; discussion 651

PubMed ID

15028139

Digital Object Identifier (DOI)

10.1227/01.neu.0000109043.56063.ba

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