Microsurgical Anatomy of the Temporal Lobe and Its Implications on Temporal Lobe Epilepsy Surgery

Küçükyürük, Barış; Richardson, R. Mark; Wen, Hung Tzu; Fernández-Miranda, Juan C.; Rhoton, Albert L.

doi:10.1155/2012/769825

Cited by 39 publications

(47 citation statements)

References 47 publications

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“…9,18 The inferior choroidal point was used as a landmark to separate the anterior and posterior hippocampus. 20 The cingulate gyrus was divided into anterior and posterior areas. The anterior cingulate gyrus was located rostral to the VPC line and the posterior cingulate gyrus was located caudal to the VPC line.…”

Section: Implantation Of Seeg Electrodesmentioning

confidence: 99%

Connectivity of the frontal and anterior insular network: a cortico-cortical evoked potential study

Enatsu

González-Martínez

Bulacio

et al. 2016

JNS

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OBJECT The frontal and insular fiber network in humans remains largely unknown. This study investigated the connectivity of the frontal and anterior insular network in humans using cortico-cortical evoked potential (CCEP). METHODS This retrospective analysis included 18 patients with medically intractable focal epilepsy who underwent stereoelectroencephalography and CCEP. Alternating 1-Hz electrical stimuli were delivered to parts of the frontal lobe and anterior insula (prefrontal cortex [PFC], ventrolateral and dorsolateral premotor area [vPM and dPM, respectively], presupplementary motor area [pre-SMA], SMA, frontal operculum, and anterior insula). A total of 40–60 stimuli were averaged in each trial to obtain CCEP responses. The distribution of CCEP was evaluated by calculating the root mean square of CCEP responses. RESULTS Stimulation of the PFC elicited prominent CCEP responses in the medial PFC and PMs over the ipsilateral hemisphere. Stimulation of the vPM and dPM induced CCEP responses in the ipsilateral frontoparietal areas. Stimulation of the pre-SMA induced CCEP responses in the ipsilateral medial and lateral frontal areas and contralateral pre-SMA, whereas stimulation of the SMA induced CCEP responses in the bilateral frontoparietal areas. Stimulation of the frontal operculum induced CCEP responses in the ipsilateral insula and temporal operculum. CCEPs were observed in the ipsilateral medial, lateral frontal, and frontotemporal operculum in the anterior insular stimulation. Stimulation of the vPM and SMA led to the network in the dominant hemisphere being more developed. CONCLUSIONS Various regions within the frontal lobe and anterior insula were linked to specific ipsilateral and contralateral regions, which may reflect distinct functional roles.

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Section: Implantation Of Seeg Electrodesmentioning

confidence: 99%

Connectivity of the frontal and anterior insular network: a cortico-cortical evoked potential study

Enatsu

González-Martínez

Bulacio

et al. 2016

JNS

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“…16 Extensive literature data are also available on the delicate neural structures supplied by the AChA, which include the optic tract, cerebral peduncle, and posterior limb and retrolenticular part of the internal capsule known to carry the corticospinal tract and optic radiations, respectively. 2,10,21,26 Scarce and sometimes conflicting data are present in the literature on the complicated course of the AChA within the perimesencephalic cisterns, in addition to its perforating branches. 24 Perforators supplying critical areas arise mostly from the cisternal segment, where the artery and its branches are intimately related to the optic tract.…”

mentioning

confidence: 99%

Microsurgical anatomy of the cisternal anterior choroidal artery with special emphasis on the preoptic and postoptic subdivisions

Tanrıöver

Küçükyürük

Ulu

et al. 2014

JNS

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Object The object of this study was to delineate the microsurgical anatomy of the cisternal segment of the anterior choroidal artery (AChA). The authors also propose a new classification of this segment on the basis of its complicated course within the carotid and crural cisterns in relation to important neurovascular structures, and the site of origin, course, and areas of supply of perforating arteries. Methods Thirty cadaveric cerebral hemispheres injected with colored latex were dissected under surgical magnification to view the cisternal segment of the AChA and its perforators. Fiber dissections using the Klingler technique were performed in two additional latex injected hemispheres to follow the penetration points, courses, and terminal areas of supply of perforating branches that arise from the cisternal segment of the AChA. Results The cisternal segment of the AChA was divided into pre- and postoptic parts that meet at the artery's genu, the most medial extension point of the cisternal segment where the artery makes an abrupt turn after passing under the optic tract. The preoptic part of the AChA extended from its origin at the inferomedial side of the internal carotid artery to the artery's genu, which is commonly located just inferomedial to the initial part of the optic tract. The postoptic part coursed within the crural cistern and extended from the genu to the inferior choroidal point. The genu of the AChA was 8 mm medial to the artery's origin and was located medial to the optic tract in 13% of the hemispheres. The postoptic part was longer than the preoptic part in all hemispheres and had more perforating arteries supplying critical deep structures (preoptic 3.4 per hemisphere vs postoptic 4.6 per hemisphere), and these results were statistically significant (p = 0.01). At the preoptic part, perforating arteries arose from the superolateral portion of the artery and coursed laterally; at the postoptic part, perforators arose from the inferomedial portion of the artery and coursed medially. Perforating arteries from both segments passed most commonly to the optic tract, followed by the anterior segment and apex of uncus in the preoptic part and the cerebral peduncle in the postoptic part. Conclusions Both parts of the cisternal segment of the AChA come into surgical view during surgeries for different pathologies in and around the perimesencephalic cisterns. However, attending to the artery's genu and defining pre- and postoptic parts during surgery may help the surgeon locate the origin and eventual course of these perforators, and even estimate the terminal areas of supply of most of the perforating arteries. The proposed classification system can prove helpful in planning any operative procedure along the crural cistern and may reduce the probability of inadvertent injury to perforating branches of the cisternal segment.

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“…The head of the hippocampus (pes hippocampus) is located just posterior and inferior to the amygdala and forms the medial border of the anterior temporal horn. The body of the hippocampus forms the medial floor of the temporal horn, while the collateral eminence (intraventricular projection of collateral sulcus) forms the lateral floor [5,6] .…”

Section: Amygdala and Hippocampal Formationmentioning

confidence: 99%

“…It is positioned just behind the head of the hippocampus and marks the posterior limit of the uncus and the beginning of the choroidal fissure. The carotid-choroidal line, an imaginary line connecting the internal carotid artery bifurcation and inferior choroidal point, has been used by many neurosurgeons as an intraoperative landmark for the superior limit of amygdala resection [6] .…”

Section: Endorhinal Sulcus and Inferior Choroidal Pointmentioning

confidence: 99%

Anterior Temporal Sulcus: A Reliable Intraoperative Landmark for Accurately Delineating the Superior Limit of Amygdala Resection during Anterior Temporal Lobectomy

Tan¹,

Byrne²

2015

Stereotact Funct Neurosurg

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Background: Reliable anatomical landmarks are essential to avoiding injuries to the optic tract, anterior choroidal artery and basal ganglia during anterior temporal lobectomy (ATL). We describe an anatomic landmark, specifically the anterior temporal sulcus (ATS), as a reliable method to define the anterior portion of the endorhinal sulcus and the superior limit of amygdala resection. Methods: A total of 25 consecutive patients undergoing ATL at Rush University Medical Center (RUMC) were identified, and their preoperative brain magnetic resonance imaging (MRI) studies were analyzed. Results: All patients underwent successful ATL without any complication. There was no injury to the optic tract, anterior choroidal artery or basal ganglia using ATS as the landmark for the superior limit of amygdala resection. The ATS was clearly identifiable on coronal preoperative MRI in 48 out of 50 temporal lobes (96%). The ATS was present in all 25 left temporal lobes (100%); 2 of the 25 right temporal lobes had absent ATS (8%). Following the ATS posteriorly on coronal MRI, it led to the endorhinal sulcus and accurately predicted the superior extent of amygdala resection in all 25 patients (48 temporal lobes). Conclusion: The ATS is a reliable anatomical landmark that accurately delineates the superior border of the amygdala during ATL.

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Microsurgical Anatomy of the Temporal Lobe and Its Implications on Temporal Lobe Epilepsy Surgery

Cited by 39 publications

References 47 publications

Connectivity of the frontal and anterior insular network: a cortico-cortical evoked potential study

Connectivity of the frontal and anterior insular network: a cortico-cortical evoked potential study

Microsurgical anatomy of the cisternal anterior choroidal artery with special emphasis on the preoptic and postoptic subdivisions

Anterior Temporal Sulcus: A Reliable Intraoperative Landmark for Accurately Delineating the Superior Limit of Amygdala Resection during Anterior Temporal Lobectomy

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