Redefining Access to the Mesiotemporal Lobe: The Transplanum Polare Approach with Cadaveric and Operative Video...

Objectives: This study aims to define the surgical anatomy, technical feasibility, advantages, and limitations of the TPPA through detailed cadaveric dissection and a representative clinical case, evaluating its potential as a safe and effective alternative to traditional approaches to the mesiotemporal lobe. Methods: A cadaveric dissection was performed on one adult head injected with colored latex, using standard microsurgical instruments and high-definition video documentation. Each procedural step was recorded and illustrated with cadaveric photographs. Additionally, a clinical case of mesiotemporal cavernous hemangioma resected via TPPA is presented, including an operative video. Results: The dissection demonstrated a direct and safe trajectory to the amygdala and hippocampal head, with clear identification of key vascular and white matter landmarks. In the clinical case, the lesion was completely resected with no postoperative neurological deficits. Conclusions: The TPPA represents a novel microsurgical corridor to the mesiotemporal region, minimizing cortical disruption, Sylvian fissure dissection, and manipulation of middle cerebral artery branches. Although its exposure is limited posteriorly, the TPPA could offer an optimal balance between functional preservation and surgical accessibility, constituting a valuable addition to the modern microsurgical armamentarium.