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Acta Neurochirurgica
Published in: Acta Neurochirurgica 1/2017

01-01-2017 | Technical Note - Brain Tumors

Efficacy of the transtemporal approach with awake brain mapping to reach the dominant posteromedial temporal lesions

Authors: Kentaro Iijima, Kazuya Motomura, Lushun Chalise, Masaki Hirano, Atsushi Natsume, Toshihiko Wakabayashi

Published in: Acta Neurochirurgica | Issue 1/2017

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Abstract

Background

Surgeries for lesions in the dominant hippocampal and parahippocampal gyrus involving the posteromedial temporal regions are challenging to perform because they are located close to Wernicke’s area; white matter fibers related with language; the optic radiations; and critical neurovascular structures. We performed a transtemporal approach with awake functional mapping for lesions affecting the dominant posteromedial temporal regions. The aim of this study was to assess the feasibility, safety, and efficacy of awake craniotomy for these lesions.

Methods

We retrospectively reviewed four consecutive patients with tumors or cavernous angiomas located in the left hippocampal and parahippocampal gyrus, which further extended to the posteromedial temporal regions, who underwent awake surgery between December 2014 and January 2016.

Results

Four patients with lesions associated with the left hippocampal and parahippocampal gyrus, including the posteromedial temporal area, who underwent awake surgery were registered in the study. In all four patients, cortical and subcortical eloquent areas were identified via direct electrical stimulation. This allowed determination of the optimal surgical route to the angioma or tumor, even in the language-dominant hippocampal and parahippocampal gyrus. In particular, this approach enabled access to the upper part of posteromedial temporal lesions, while protecting the subcortical language-related fibers, such as the superior longitudinal fasciculus.

Conclusions

This study revealed that awake brain mapping can enable the safe resection of dominant posteromedial temporal lesions, while protecting cortical and subcortical eloquent areas. Furthermore, our experience with four patients demonstrates the feasibility, safety, and efficacy of awake surgery for these lesions.
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Metadata
Title
Efficacy of the transtemporal approach with awake brain mapping to reach the dominant posteromedial temporal lesions
Authors
Kentaro Iijima
Kazuya Motomura
Lushun Chalise
Masaki Hirano
Atsushi Natsume
Toshihiko Wakabayashi
Publication date
01-01-2017
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 1/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-016-3035-6

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