April 29, 2016
Here's another video describing a tenants for Anteromedial Temporal Lobectomy and Amygdalohippocampectomy. This is a 35 year old male who presented with seizures and my evaluation revealed a ring enhanced lesion within the non-dominant right temporal lobe, that was finally diagnosed as a high grade glioma. Patient underwent a right sided front temporal craniotomy. Here's the Sylvian fissure, temporal lobe frontal lobe three-and-a-half to four centimeter of the non dominant temporal lobe length, can be removed safely. A number three, Penfield dissector was used to measure the length of the temporal lobe that will be removed. This case four centimeter on the non-dominant side is relatively safe. A Corticectomy was conducted on the crown of the superior temporal gyrus. Supial disection continued surface vessels were coagulated and cut. Next, the vertical corticectomy perpendicular to the floor of the middle fossa was performed. I continue dissection and disconnection of the white matter without entering the ventricle. An important landmark is a protuberance at the floor of the middle fossa, where I direct my white matter, the section toward. Here's the exposure of the temporal horn of the lateral ventricle, just that the area of the middle of the temporal gyrus. Here's the protuberance that I discussed a moment ago. I direct my white matter to section, tour that protuberance until the lateral neo cortical resection is completed and the temporal lobe is extracted. Here's the continuation of our white matter to dissection. Suppial removal removal of the mass and the tumor, are the safest methods of resection along the medial temporal lobe. Now that the lateral neo cortical resection is completed, I'll go ahead and find the branches through their Sylvian arachnoid bands and also find the anterior edge of the choroid plexus it line drawn between these two landmarks defines the most superior aspect of our Amex Colectomy. A piece of cotton padding may be left behind just along the interior edge of the Cord plexus for anatomic orientation. Here again, this day, hippocampus affected by the tumor. Here's the choroid plexus. Here's the MCA branches through the arachnoid bands of the Sylvian fissure align connecting the two would demarcate the most posterior and superior extend our Amex Colectomy as was outlined using the bipolar forceps. Here's the disconnection of the amygdala, the arachnoid bands and the peal surfaces over the medial temporal lobe and basal systems are protected during the Amex Colectomy, the third nerve may be encountered. Here's the piece of the amygdala that was removed. I did show a portion of the uncus is evacuated against a peeling until the third nerve is encountered At all times, the edge of the tentorium is kept in mind. Now I am further diverting my attention toward the hippocampus that is infiltrated by the tumor. In this case,the anterior portion of the hippocampus or PEs hippocampus is removed not necessarily in block because it's infiltrated by the tumor. Now that the entire portion of the hippocampus and the part effected by the mass is excised, I continue so pure removal of the Para hippocampus until the arachnoid bands over the basal cisterns are exposed. The dissection is directed primarily lateral to the choroid plexus. Here is removal of the posterior part of the hippocampus somewhat still affected by the tumor. You can see this discolored. The tumor can infiltrate the arachnoid bands over the basal cisterns. Therefore careful attention is paid to avoid any injury to these arachnoid bands. Here are some of the PCA branches through the arachnoid of the basal cisterns. Some of the effected more laterally located arachnoid bands are also removed. Here's that brainstem through the arachnoid bands of the basal cisterns, is the PCA. Hemostasis is secured. The walls of the resection cavity are investigated to make sure nor residual tumors apparent. Next hemostasis is achieved. More demagnified view or operative corridor is provided, and here's the postoperative MRI scan, which revealed Coristatal removal of the tumor. Thank you.
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