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

  • Technical Note - Brain Tumors
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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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Acknowledgments

The authors would like to thank Ms. Junko Sugiura, Mr. Daisuke Hara, Mr. Yasuyuki Matsui (Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan) for their wonderful technical assistance.

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

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

Authors
  1. Kentaro Iijima
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  2. Kazuya Motomura
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  3. Lushun Chalise
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  4. Masaki Hirano
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  5. Atsushi Natsume
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  6. Toshihiko Wakabayashi
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Corresponding author

Correspondence to Kazuya Motomura.

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Funding

Kazuya Motomura was supported by grants from a Grant-in-Aid (B) for Scientific Research from the Ministry of Health, Labor, and Welfare, Japan. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Iijima, K., Motomura, K., Chalise, L. et al. Efficacy of the transtemporal approach with awake brain mapping to reach the dominant posteromedial temporal lesions. Acta Neurochir 159, 177–184 (2017). https://doi.org/10.1007/s00701-016-3035-6

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  • DOI: https://doi.org/10.1007/s00701-016-3035-6

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