title: Transzygomatic approach with anteriorly limited inferior temporal gyrectomy for large medial tentorial meningiomas.
abstract: BACKGROUND
  Tentorial meningiomas near the middle third of the medial tentorial edge with supratentorial extension are usually removed via the subtemporal approach. This approach, however, may not be practical, especially for huge tumors extending to the posterior subtemporal space. This study describes the use of the transzygomatic approach with anteriorly limited inferior temporal gyrectomy (TZ-AITG) to remove these large tumors.
  
  
  METHODS
  Between 2008 and 2012, five patients with symptomatic tentorial meningiomas (median diameter, 5.2 cm; range, 4.0-5.7 cm) near the middle third of the medial tentorial edge with supratentorial extension underwent TZ-AITG, consisting of zygomatic osteotomy, low-positioned craniotomy, and resection of the inferior temporal gyrus around 4 cm from the tip.
  
  
  RESULTS
  Tumors were completely resected in all patients. Postoperatively, none had a newly developed neurological morbidity, and none died. Of three patients with preoperative hemianopia, two showed improvement and one remained stationary. One patient with preoperative hemiparesis recovered completely. All patients returned to their normal activities during the follow-up period. Surgical morbidities included epidural hematoma and chronic subdural hematoma in one patient each, with both requiring evacuation.
  
  
  CONCLUSIONS
  TZ-AITG may be a good alternative to the subtemporal approach for large tentorial meningiomas near the middle third of the medial tentorial edge. TZ-AITG provides access to the lesions and visualization of the middle fossa, facilitating early feeder control while minimizing brain retraction, thus reducing potential injury to the vein of Labbé. TZ-AITG is also safe and feasible in minimizing neurological compromise.
authors: Department of Neurological Surgery, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Eun Jung
authors: EJ
authors: Lee
authors: Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors: Eun Suk
authors: ES
authors: Park
authors: Department of Neurological Surgery, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Young Hyun
authors: YH
authors: Cho
authors: Department of Neurological Surgery, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Seok Ho
authors: SH
authors: Hong
authors: Department of Neurological Surgery, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Jeong Hoon
authors: JH
authors: Kim
authors: Department of Neurological Surgery, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. cjkim@amc.seoul.kr.
authors: Chang Jin
authors: CJ
authors: Kim
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D011612:Psychosurgery / Q000009:adverse effects / Q000379:methods*
keywords: Language disorders; Subtemporal approach; Surgical approach; Tentorial meningioma; Tentorium incisura; Visual pathway