Middle temporal gyrus versus inferior temporal gyrus transcortical approaches to high-grade astrocytomas in the mediobasal temporal lobe: A comparison of outcomes, functional restoration, and surgical considerations

Alfredo Quinones-Hinojosa, Shaan M. Raza, Ishrat Ahmed, Jordina Rincon-Torroella, Kaisorn Chaichana, Alessandro Olivi

Research output: Chapter in Book/Report/Conference proceedingChapter

4 Scopus citations

Abstract

Introduction High-grade astrocytomas of the mesial temporal lobe may pose surgical challenges. Several approaches (trans-sylvian, subtemporal, and transcortical) have been designed to circumnavigate the critical neurovascular structures and white fiber tracts that surround this area. Considering the paucity of literature on the transcortical approach for these lesions, we describe our institutional experience with transcortical approaches to Grade III/IV astrocytomas in the mesial temporal lobe. Methods Between 1999 and 2009, 23 patients underwent surgery at the Johns Hopkins Medical Institutions for Grade III/IV astrocytomas involving the mesial temporal lobe (without involvement of the temporal neocortex). Clinical notes, operative records, and imaging were reviewed. Results Thirteen patients had tumors in the dominant hemisphere. All patients underwent surgery via a transcortical approach (14 via the inferior temporal gyrus and 9 via the middle temporal gyrus). Gross total resection was obtained in 92% of the cohort. Neurological outcomes were: clinically significant stroke (2 patients), new visual deficits (2 patients), new speech deficit (1 patient); seizure control (53%). Conclusions In comparison to reported results in the literature for the transylvian and subtemporal approaches, the transcortical approach may provide the access necessary for a gross total resection with minimal neurological consequences. In our series of patients, there was no statistically significant difference in outcomes between the middle temporal gyrus versus the inferior temporal gyrus trajectories.

Original languageEnglish (US)
Title of host publicationActa Neurochirurgica, Supplementum
PublisherSpringer-Verlag Wien
Pages159-164
Number of pages6
Volume124
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Publication series

NameActa Neurochirurgica, Supplementum
Volume124
ISSN (Print)0065-1419
ISSN (Electronic)2197-8395

Keywords

  • High-grade astrocytoma
  • Mesial temporal lobe
  • Transcortical approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Quinones-Hinojosa, A., Raza, S. M., Ahmed, I., Rincon-Torroella, J., Chaichana, K., & Olivi, A. (2017). Middle temporal gyrus versus inferior temporal gyrus transcortical approaches to high-grade astrocytomas in the mediobasal temporal lobe: A comparison of outcomes, functional restoration, and surgical considerations. In Acta Neurochirurgica, Supplementum (Vol. 124, pp. 159-164). (Acta Neurochirurgica, Supplementum; Vol. 124). Springer-Verlag Wien. https://doi.org/10.1007/978-3-319-39546-3_25