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

Ruth Lau1, Roberto Rodriguez Rubio2, Juan Martino3

  • 1Skull 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.

World Neurosurgery
|April 14, 2019
PubMed

Insights

This study demonstrates a new endoscopic surgical approach to the lateral ventricle atrium through the anterior middle temporal gyrus (MTG). This minimally invasive technique safely accesses the atrium while preserving critical white matter tracts.

Area of Science:

  • Neurosurgery
  • Minimally Invasive Techniques
  • Neuroanatomy

Background:

  • The lateral ventricle atrium is a common site for tumors, but its deep location and proximity to vital neurovascular structures pose surgical challenges.
  • Traditional surgical access is limited, risking damage to eloquent white matter (WM) tracts and cortical areas.

Purpose of the Study:

  • To evaluate the feasibility and safety of an endoscopic surgical corridor to the lateral ventricle atrium.
  • To investigate an anterior middle temporal gyrus (MTG) approach for accessing the atrium.

Main Methods:

  • Radiological assessment of surgical trajectories in 10 patients.
  • Surgical simulation on 24 cadaveric specimens using a transzygomatic corridor and temporal craniotomy.
  • Anatomical dissection of white matter tracts using Klinger's method.

Main Results:

  • An optimal entry angle through the anterior MTG was identified, relating to the temporal horn and Sylvian fissure.
  • The approach demonstrated a mean transparenchymal distance of 24.55 ± 4.3 mm to the atrium.
  • White matter dissections confirmed no violation of optic radiations or major fasciculi.

Conclusions:

  • An anterior endoscopic approach to the lateral ventricle atrium via the anterior MTG is feasible.
  • This technique preserves the functional integrity of eloquent cortex and critical white matter tracts.
Abstract

Keywords:
Anterior middle temporalAtriumChoroidal arteriesEndoscopeMeyer's loopOptic radiationsPerisylvian networkSurgical approach

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