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Redefining Access to the Mesiotemporal Lobe: The Transplanum Polare Approach with Cadaveric and Operative Video
Jesse Shamsul1, Alessandro Pesaresi1,2, Daniele Starnoni1,3
1Department of Neurosurgery, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
Brain Sciences
|April 27, 2026
Summary
The trans-pterional pre-auricular approach (TPPA) offers a novel, safe surgical corridor to the mesiotemporal lobe. This technique minimizes brain disruption, providing a valuable alternative for neurosurgery.
Area of Science:
- Neurosurgery
- Microsurgery
- Surgical Anatomy
Background:
- Traditional approaches to the mesiotemporal lobe can involve significant cortical disruption.
- There is a need for minimally invasive surgical corridors to access mesiotemporal pathologies.
Purpose of the Study:
- To define the surgical anatomy, feasibility, and limitations of the trans-pterional pre-auricular approach (TPPA).
- To evaluate the TPPA as a safe and effective alternative for mesiotemporal lobe surgery.
Main Methods:
- Detailed cadaveric dissection with high-definition video documentation.
- Presentation of a clinical case involving mesiotemporal cavernous hemangioma resection via TPPA.
Main Results:
- The TPPA provides a direct, safe trajectory to the amygdala and hippocampal head.
- Complete resection of a mesiotemporal cavernous hemangioma was achieved with no postoperative deficits.
Conclusions:
- The TPPA is a novel microsurgical corridor that minimizes cortical disruption and manipulation of critical neurovascular structures.
- The TPPA offers a balance between functional preservation and surgical accessibility for mesiotemporal region pathologies.
