title: New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment.
abstract: OBJECTIVE
  The temporal horn of the lateral ventricle is a complex structure affected by specific pathological conditions. Current approaches to the temporal horn involve a certain amount of corticotomy and white matter disruption. Surgeons therefore set aside anterior temporal lobectomy as a last resource and avoid it in the dominant hemisphere. The authors propose a minimally invasive endoscopic intraventricular approach to the temporal horn and describe a standardized analysis and technical assessment of the feasibility of this approach.
  
  
  METHODS
  To determine the best trajectory, angulation, and entry point to the temporal horn of the lateral ventricle, the authors evaluated 50 cranial MRI studies (100 temporal lobes) from healthy patients. They studied and systematized the neurosurgical endoscopic anatomy. They also simulated the proposed approach in 9 cadaveric specimens (18 approaches).
  
  
  RESULTS
  Mean scalp entry point coordinates (± SD) were 2.7 ± 0.28 cm lateral to the inion and 5.6 ± 0.41 cm superior to the inion. The mean total distance from the uncal recess to the scalp (± SD) was 10.64 ± 0.6 cm. The mean total intraparenchymal distance crossed by the endoscope was 3.76 ± 0.36 cm. The approach was successfully completed in all studied specimens.
  
  
  CONCLUSIONS
  In this study, the endoscopic intraventricular approach to the temporal horn is standardized. The morphometric analysis makes this approach anatomically feasible and replicable. This approach provides minimally invasive endoscopic access to the uncal recess, amygdala, hippocampus, fornix, and paraventricular temporal lobe structures. The following essential strategies enabled access to and maneuverability inside the temporal horn: tailored preoperative planning of the trajectory and use of anatomical and radiological references, constant irrigation, and an angled endoscopic lens. Safety assessment and novel instruments and techniques may be proposed to advance this very promising route to pathological changes in the temporal lobe.
authors.affiliation: Departments of Neurosurgery and.
authors.forename: Jose Juan González
authors.initials: JJ
authors.lastname: Sánchez
authors.forename: Jordina
authors.initials: J
authors.lastname: Rincon-Torroella
authors.forename: Alberto
authors.initials: A
authors.lastname: Prats-Galino
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
authors.forename: Joan
authors.initials: J
authors.lastname: Berenguer
authors.forename: Enrique Ferrer
authors.initials: EF
authors.lastname: Rodríguez
authors.forename: Arnau
authors.initials: A
authors.lastname: Benet
mesh_terms: D002102:Cadaver; D003198:Computer Simulation; D005240:Feasibility Studies; D006801:Humans; D020547:Lateral Ventricles / Q000033:anatomy & histology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D044583:Neuroendoscopy / Q000379:methods*; D015203:Reproducibility of Results; D013702:Temporal Lobe / Q000033:anatomy & histology / Q000601:surgery*
keywords: endoscopic anatomy; intraventricular approach; minimally invasive neurosurgery; surgical technique; ventricular temporal horn