title: Microsurgical anatomy of the transsylvian translimen insula approach to the mediobasal temporal lobe: Technical considerations and case illustration.
abstract: BACKGROUND
  Various vascular, neoplastic, and epileptogenic pathologies occur in the mediobasal temporal region. A transsylvian translimen insula (TTI) approach can be used as an alternative to temporal transcortical approach to the mediobasal temporal region. The aim of this study was to demonstrate the surgical anatomy of the TTI approach, including the gyral, sulcal, and vascular anatomy in and around the limen insula. The use of this approach is illustrated in the resection of a complex arteriovenous malformation.
  
  
  METHODS
  The TTI approach to the mediobasal temporal region was performed on three silicone-injected cadaveric heads. The gyral, sulcal, and arterial anatomy of the limen insula was studied in six formalin-fixed injected hemispheres.
  
  
  RESULTS
  The TTI approach provided access to the anterior and middle segments of the mediobasal temporal lobe region as well as allowing access to temporal horn of the lateral ventricle. Using this approach we were able to successfully resect an arteriovenous malformation of the dominant medial temporal lobe.
  
  
  CONCLUSIONS
  The TTI approach provides a viable surgical route to the region of mediobasal temporal lobe region. This approach offers an advantage over the temporal transcortical route in that there is less risk of damage to optic radiations and speech area in the dominant hemisphere.
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Straus
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Byrne
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Sani
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Serici
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Roham
authors.initials: R
authors.lastname: Moftakhar
keywords: Arteriovenous malformation; mesial temporal lobe; mesial temporal sclerosis; transinsular; translimen insula; transsylvian; uncus