Special Surgical Aspects

Illustration of anatomical principles for different surgical approaches to the temporal lobe such as standard temporal lobectomy, keyhole resection, and amygdalohippocampectomy. A detailed presentation of the anatomy encountered during transsylvian approaches to aneurysms as well as during approaches to the tip of inferior horn of the lateral ventricle for amygdalohippocampectomy is given. The basal ganglia and possible variants of the middle cerebral artery must be considered. An additional approach to perform amygdalohippocampectomy via the subtemporal route and further indications for temporobasal approaches are presented. Advantages as well as disadvantages are discussed. To optimize these approaches, craniotomy must be carried out as close to the skull base as possible. The cochlear labyrinth, sigmoid sinus, vein of Labbe, and basal cerebral vessels must be taken into consideration. Difficulties of the temporobasal intradural approaches, close to the superior margin of the petrous bone, are discussed. The challenge is to mobilize the temporal lobe from the cranial base without damaging the important short bridging veins in this area.