The importance of preoperative planning to perform safely temporal lobe surgery

Neurosurgeons should know the anatomy required for safe temporal lobe surgery approaches. The pre-sent study aimed to determine the angles and distances necessary to reach the temporal stem and tem-poral horn in surgical approaches for safe temporal lobe surgery by using a 3.0 T magnetic resonance imaging technique in post-mortem human brain hemispheres fixed by the Klingler method. In our study, 10 post-mortem human brain hemisphere specimens were fixed according to the Klingler method. Magnetic resonance images were obtained using a 3.0 T magnetic resonance imaging scanner after fixa-tion. Surgical measurements were conducted for the temporal stem and temporal horn by magnetic res-onance imaging, and dissection was then performed under a surgical microscope for the temporal stem. Each stage of dissection was achieved in high-quality three-dimensional images. The angles and distances to reach the temporal stem and temporal horn were measured in transcortical T1, trans-sulcal T1-2, transcortical T2, trans-sulcal T2-3, transcortical T3, and subtemporal trans-collateral sulcus approaches. The safe maximum posterior entry point for anterior temporal lobectomy was measured as 47.16 +/- 5.0 0 mm. Major white-matter fibers in this region and their relations with each other are shown. The dis-tances to the temporal stem and temporal horn, which are important in temporal lobe surgical interven-tions, were measured radiologically, and safe borders were determined. Surgical strategy and preoperative planning should consider the relationship of the lesion and white-matter pathways. (c) 2021 Elsevier Ltd. All rights reserved.