title: Middle Temporal Gyrus Versus Inferior Temporal Gyrus Transcortical Approaches to High-Grade Astrocytomas in the Mediobasal Temporal Lobe: A Comparison of Outcomes, Functional Restoration, and Surgical Considerations.
abstract: High-grade astrocytomas of the mesial temporal lobe may pose surgical challenges. Several approaches (trans-sylvian, subtemporal, and transcortical) have been designed to circumnavigate the critical neurovascular structures and white fiber tracts that surround this area. Considering the paucity of literature on the transcortical approach for these lesions, we describe our institutional experience with transcortical approaches to Grade III/IV astrocytomas in the mesial temporal lobe.
  
  
  
  Between 1999 and 2009, 23 patients underwent surgery at the Johns Hopkins Medical Institutions for Grade III/IV astrocytomas involving the mesial temporal lobe (without involvement of the temporal neocortex). Clinical notes, operative records, and imaging were reviewed.
  
  
  
  Thirteen patients had tumors in the dominant hemisphere. All patients underwent surgery via a transcortical approach (14 via the inferior temporal gyrus and 9 via the middle temporal gyrus). Gross total resection was obtained in 92 % of the cohort. Neurological outcomes were: clinically significant stroke (2 patients), new visual deficits (2 patients), new speech deficit (1 patient); seizure control (53 %).
  
  
  
  In comparison to reported results in the literature for the transylvian and subtemporal approaches, the transcortical approach may provide the access necessary for a gross total resection with minimal neurological consequences. In our series of patients, there was no statistically significant difference in outcomes between the middle temporal gyrus versus the inferior temporal gyrus trajectories.
authors.affiliation: Neurosurgical Oncology Outcomes Laboratory, Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. aquinon2@jhmi.edu.|Brain Tumor Stem Cell Laboratory, Department of Neurosurgery and Oncology, 1550 Orleans Street, Cancer Research Building II Room 247, Baltimore, MD, 21231, USA. aquinon2@jhmi.edu.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones-Hinojosa
authors.affiliation: Neurosurgical Oncology Outcomes Laboratory, Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Shaan M
authors.initials: SM
authors.lastname: Raza
authors.affiliation: Neurosurgical Oncology Outcomes Laboratory, Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Ishrat
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Neurosurgical Oncology Outcomes Laboratory, Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Jordina
authors.initials: J
authors.lastname: Rincon-Torroella
authors.affiliation: Neurosurgical Oncology Outcomes Laboratory, Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Kaisorn
authors.initials: K
authors.lastname: Chaichana
authors.affiliation: Neurosurgical Oncology Outcomes Laboratory, Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
mesh_terms: D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D013064:Speech Disorders / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D013702:Temporal Lobe / Q000601:surgery*; D014213:Tretoquinol; D047368:Tumor Burden; D014786:Vision Disorders / Q000453:epidemiology
chemical_list: D014213:Tretoquinol
keywords: High-grade astrocytoma; Mesial temporal lobe; Transcortical approach