Info

Note: Children are aged less than 16 years at operation.

Note: Children are aged less than 16 years at operation.

Most temporal resections involve removal of both superficial and deep structures and it is the extent of that removal which varies. Most temporal lobectomies are two-stage procedures: first, resection of the neocortical structures, followed by removal of the hippocampus and parahippocampal gyrus, and it is only the relative extent of lateral and medial resection which varies. Certain anatomical boundaries are imposed upon the surgeon. In the dominant hemisphere, the majority of the superior temporal gyrus must be preserved. The insular cortex must remain undisturbed if the risk of a manipulation hemiplegia is to be avoided. The posterior extent of the resection is governed by the risk of hemianopia. In adults, the limit is around 6.5 cm; in smaller children, it is convenient to use the height of the temporal lobe at the mid-Sylvian point as the posterior extent of the resection. Spencer has described a technique for gaining access to the posterior mesial temporal structures without undue neo-cortical destruction [13]. Complete removal of benign tumours, dysembryonic neuroepithelial tumours (DNETs), hamartomas and the like is very desirable but, where they are adherent to important vessels and removal could cause hemiplegia if these vessels were damaged, a small portion may be left without detriment to the outcome. Some surgeons use the micro scope and the CUSA for the deep parts of a temporal lobe removal.

The en-bloc temporal lobectomy described by Falconer provides a large specimen, which is suitable for both physiological and pathological analysis. The standard procedure performed in the authors' unit obtains a block specimen using the technique described by Spencer to maximize hippocampal removal. The patient is supine, with a sandbag under the ipsilateral shoulder, with the head turned to the contralateral side to achieve a horizontal. A question-mark incision starts just anterior to the level of the zygoma, curving superiorly and posteriorly behind the ear and extending forwards to just superior to the external angular process of the frontal bone. The surgeon may then elevate either an osteo-plastic or a free flap. It is important to position the inferior limit of the bone flap as close to the floor of the middle fossa as possible. The inferior burr-hole should be placed just superior to the zygoma and the anterior burr-hole as close to the base of the sphenoid wing as possible.

The craniotome can then be used to cut a bone flap based along the sphenoid wing which extends several centimetres behind the ear. Further bone is then rongeured off the inferior margin towards the middle fossa floor and anteriorly towards the temporal pole. A dural flap based superiorly is then elevated, exposing the

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

Get My Free Ebook


Post a comment