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Temporal mediobasal tumors: a proposal for classification according to surgical anatomy

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Abstract

Objective

Development of a classification for temporal mediobasal tumors based on anatomical and neuroradiological aspects to help evaluate surgical accessibility and risk.

Methods

Preoperative magnetic resonance imaging, surgical approaches and outcomes of 235 patients with a temporal mediobasal tumor were analyzed retrospectively. Surgical landmarks were defined in accordance with operative anatomy. Previous classifications of these tumors were reviewed and a new classification system was developed.

Results

The new classification system recognises four types of temporal mediobasal tumor based on anatomical landmarks, location, and size. Type A comprises lesions confined to the uncus, hippocampus, parahippocampus, and/or amygdala. Type B comprises lesions in the area immediately lateral to the structures where type A tumors are located but sparing lateral gyri. Type C tumors are larger lesions, which occupy the area of type A and type B simultaneously. Type D tumors originate from the temporal mediobasal region and invade into the adjacent structures of the temporal stem, insular cortex, claustrum, putamen, or pallidum. The area occupied by a tumor in the axial plane was divided into anterior (a) and posterior (p) subregions. Progressive grading from A to D and from “a” to “p” was based on the view that larger and more posteriorly growing tumors were more difficult to remove. Lesions located in the anterior subregion (n = 173) were easier to remove by the transsylvian route (39%) or after partial anterior lobectomy (32%). For the posterior lesions (n = 62), a subtemporal approach was more appropriate (75%).

Conclusions

Based on a series of 235 temporal mediobasal tumors, a classification system was designed to aid in decision making about operability, surgical risk, and approach.

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Acknowledgements

We are indebted to J. Scorzin for providing photograph of the autopsy specimen, to B. Meyer MD and D. Binder MD Ph.D. for discussions, to D. Haun Ph.D. for helping with the illustrations and the five senior staff members also operating on these patients. We are also grateful to Mr. M. Hunn, FRACS for valuable editorial comments.

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Author notes

  1. Ales F. Aliashkevich

    Present address: Department of Neurosurgery, Wellington Hospital, Private Bag 7902, Wellington, 6001, New Zealand

Authors and Affiliations

  1. Department of Neurosurgery, University of Bonn Medical Centre, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Johannes Schramm & Ales F. Aliashkevich

Authors
  1. Johannes Schramm
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  2. Ales F. Aliashkevich
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Corresponding author

Correspondence to Johannes Schramm.

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Comment

The present work has been carried out with the purpose of defining the optimal surgical approaches for removal of the temporal Medio-Basal Tumors (MBT), according to their anatomical landmarks, anterior-posterior location (and size). This authors’ classification does not seem to us in conflict with the previous studies undertaken by Yasargil on the tumours of the limbic and paralimbic system (4), but a rather complementary one.

We find Doctors Schramm and Aliashkevitch’s classification a clear and useful one, and –according to our own surgical anatomy studies (2) – agree with it. Most anteriorly “smaller” (i.e., Aa,Ba,Ca) temporal MBT can be removed through transsylvian approaches without or after temporal polectomy (3, 5). Most posteriorly “smaller” (i.e., Ap, Bp,Cp) temporal MBT should rather be removed through a subtemporal route without or after fusiform gyrectomy (1), to decrease the risk of visual field deficit. The larger tumors (D subtypes), whatever anterior or posterior are preferentially removed after standard (more or less partiel) temporal anterior lobectomy, and with mobilization of the frontal and parietal operculo if tumor invades the insular region. Of course, as pointed out, by the authors, design of the approach must take into account hemisphere dominance to avoid dysphasia.

The authors should be acknowledged for the useful practical recommendations taken out from their huge experience.

Marc Sindou

University of Lyon

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Schramm, J., Aliashkevich, A.F. Temporal mediobasal tumors: a proposal for classification according to surgical anatomy. Acta Neurochir (Wien) 150, 857–864 (2008). https://doi.org/10.1007/s00701-008-0013-7

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  • DOI: https://doi.org/10.1007/s00701-008-0013-7

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