New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment

Laboratory investigation

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  • 1 Departments of Neurosurgery and
  • 2 Radiology, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain;
  • 3 Department of Neurosurgery, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California;
  • 4 Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
  • 5 Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
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Object

The temporal horn of the lateral ventricle is a complex structure affected by specific pathological conditions. Current approaches to the temporal horn involve a certain amount of corticotomy and white matter disruption. Surgeons therefore set aside anterior temporal lobectomy as a last resource and avoid it in the dominant hemisphere. The authors propose a minimally invasive endoscopic intraventricular approach to the temporal horn and describe a standardized analysis and technical assessment of the feasibility of this approach.

Methods

To determine the best trajectory, angulation, and entry point to the temporal horn of the lateral ventricle, the authors evaluated 50 cranial MRI studies (100 temporal lobes) from healthy patients. They studied and systematized the neurosurgical endoscopic anatomy. They also simulated the proposed approach in 9 cadaveric specimens (18 approaches).

Results

Mean scalp entry point coordinates (± SD) were 2.7 ± 0.28 cm lateral to the inion and 5.6 ± 0.41 cm superior to the inion. The mean total distance from the uncal recess to the scalp (± SD) was 10.64 ± 0.6 cm. The mean total intraparenchymal distance crossed by the endoscope was 3.76 ± 0.36 cm. The approach was successfully completed in all studied specimens.

Conclusions

In this study, the endoscopic intraventricular approach to the temporal horn is standardized. The morphometric analysis makes this approach anatomically feasible and replicable. This approach provides minimally invasive endoscopic access to the uncal recess, amygdala, hippocampus, fornix, and paraventricular temporal lobe structures. The following essential strategies enabled access to and maneuverability inside the temporal horn: tailored preoperative planning of the trajectory and use of anatomical and radiological references, constant irrigation, and an angled endoscopic lens. Safety assessment and novel instruments and techniques may be proposed to advance this very promising route to pathological changes in the temporal lobe.

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Contributor Notes

Address correspondence to: Jose Juan González Sánchez, M.D., Ph.D., 170 Villarroel St., Barcelona 08080, Spain. email: jjgonzal@clinic.ub.es.

Please include this information when citing this paper: published online July 4, 2014; DOI: 10.3171/2014.5.JNS132309.

  • 1

    Bahuleyan B, , Fisher W, , Robinson S, & Cohen AR: Endoscopic transventricular selective amygdalohippocampectomy: cadaveric demonstration of a new operative approach. World Neurosurg 80:1781872, 2013

    • Search Google Scholar
    • Export Citation
  • 2

    Chabardès S, , Minotti L, , Hamelin S, , Hoffmann D, , Seigneuret E, & Carron R, : [Temporal disconnection as an alternative treatment for intractable temporal lobe epilepsy: techniques, complications and results.]. Neurochirurgie 54:297302, 2008. (Fr)

    • Search Google Scholar
    • Export Citation
  • 3

    Enchev Y, & Oi S: Historical trends of neuroendoscopic surgical techniques in the treatment of hydrocephalus. Neurosurg Rev 31:249262, 2008

    • Search Google Scholar
    • Export Citation
  • 4

    Falconer MA: Surgery of temporal lobe epilepsy. Proc R Soc Med 51:613616, 1958

  • 5

    Gerzeny M, & Cohen AR: Advances in endoscopic neurosurgery. AORN J 67:957965, 1998

  • 6

    Lind CR, , Tsai AM, , Law AJ, , Lau H, & Muthiah K: Ventricular catheter trajectories from traditional shunt approaches: a morphometric study in adults with hydrocephalus. J Neurosurg 108:930933, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Mapstone TB, & Ratcheson RA, Techniques of ventricular puncture. Wilkins RH, & Rengachary SS: Neurosurgery New York, McGraw-Hill, 1996. 1:151152

    • Search Google Scholar
    • Export Citation
  • 8

    Ng WH, & Valiante T: Lateral temporal lobectomy with hippocampal disconnection as an alternative surgical technique for temporal lobe epilepsy. J Clin Neurosci 17:634635, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Niemeyer P, The transventricular amygdala-hippocampectomy in temporal lobe epilepsy. Baldwin M, & Bailey P: Temporal Lobe Epilepsy Springfield, IL, Charles C Thomas, 1958. 461482

    • Search Google Scholar
    • Export Citation
  • 10

    Park YG, , Woo HJ, , Kim E, & Park J: Accuracy and safety of bedside external ventricular drain placement at two different cranial sites: Kocher's point versus forehead. J Korean Neurosurg Soc 50:317321, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Penfield W, & Baldwin M: Temporal lobe seizures and the technic of subtotal temporal lobectomy. Ann Surg 136:625634, 1952

  • 12

    Rhoton AL Jr: The cerebrum. Anatomy Neurosurgery 61:1 Suppl 37119, 2007

  • 13

    Shimizu H, , Kawai K, , Sunaga S, , Sugano H, & Yamada T: Hippocampal transection for treatment of left temporal lobe epilepsy with preservation of verbal memory. J Clin Neurosci 13:322328, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Shimizu S, , Tanaka R, , Iida H, & Fujii K: Manual occipital ventricular puncture for cerebrospinal fluid shunt surgery: can aiming be standardized?. Neurol Med Chir (Tokyo) 44:353358, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    Silbergeld DL, , Volmer DG, , Tantuwaya VS, & Eichler ME: Endoscopic transventricular hippocampectomy. J Epilepsy 8:6873, 1995

  • 16

    Smith JR, , VanderGriff A, & Fountas K: Temporal lobotomy in the surgical management of epilepsy: technical report. Neurosurgery 54:15311536, 2004

    • Search Google Scholar
    • Export Citation
  • 17

    Song JK, , Abou-Khalil B, & Konrad PE: Intraventricular monitoring for temporal lobe epilepsy: report on technique and initial results in eight patients. J Neurol Neurosurg Psychiatry 74:561565, 2003

    • Search Google Scholar
    • Export Citation

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