"Tangential" resection of medial temporal lobe arteriovenous malformations with the orbitozygomatic approach
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)
51; discussion 651
Digital Object Identifier (DOI)
Du, Rose; Young, William L.; and Lawton, Michael T., ""Tangential" resection of medial temporal lobe arteriovenous malformations with the orbitozygomatic approach" (2004). Neurosurgery. 879.