Medial Temporal Vasculature and Surgical Tips for Medial Temporal Microsurgery(<SPECIAL ISSUES>Anatomy and Operation of the Temporal Lobe and its Vicinity I)

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  • Kawai Kensuke
    Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo
  • Saito Nobuhito
    Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo

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  • 側頭葉内側の動脈と手術における留意点(<特集>側頭葉とその周辺の解剖と手術I-第25回微小脳神経外科解剖セミナー合同セッションより-)

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Abstract

It is essential to understand the microanatomy of the medial temporal structure and its vasculature to safely perform microsurgical procedures for temporal lobe epilepsy and medial temporal tumors. We review the medial temporal vasculature and provide surgical tips for medial temporal microsurgery focusing on how the uncus is associated with the anterior choroidal artery and the hippocampal sulcus is associated with the hippocampal arteries. The anterior choroidal artery runs posteriorly along the superior aspect of the uncus entering the choroid plexus. The uncal artery branches from the cisternal segment of the anterior choroidal artery, runs downward, enters the uncal sulcus and then forms anastomoses with branches of the hippocampal artery. The important perforators, particularly the capsulothalamic artery, branch from the most distal aspect of cisternal segment or sometimes from the choroidal segment. Uncal resection can be safely performed avoiding injury to the anterior choroidal artery by subpial resection; however, care must be taken not to injure its perforators running medial to the choroid plexus when resection proceeds posteriorly. Care must also be taken not to injure the lenticulostriate arteries since their proximal portions run considerably close when uncal resection proceeds upward. The medial temporal branches from the posterior cerebral artery are the hippocampal arteries, lateral posterior choroidal arteries and inferior temporal artery, entering the hippocampal sulcus and fimbriodentate sulcus, the choroid plexus via the choroidal fissure, and the collateral sulcus via parahippocampal gyrus, respectively. During the final stage of en bloc hippocampus resection, we open the hippocampal sulcus and sever the hippocampal branches deep in the sulcus with the pia mater covering the subiculum to avoid injury to the posterior cerebral artery.

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