Middle temporal gyrus approach [Neurosurgery Wiki]

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=====Middle temporal gyrus approach=====
In [[1958]], Niemeyer described a more selective [[approach]] to the [[hippocampus]] and [[amygdala]] through the [[middle temporal gyrus]]
((Niemeyer P, Baldwin M, Bailey P. The [[transventricular]] [[amygdala]]-[[hippocampectomy]] in [[temporal lobe epilepsy]]. In: Temporal Lobe Epilepsy. Springfield: Charles C Thomas; 1958:461–482)).

This [[transtemporal approach]] transcortical approach through the [[Middle temporal gyrus]] MTG not including transsulcal approach had been reported for the removal of the trigonal tumors and explained the procedure as the incision of MTG
((Andoh T, Shinoda J, Miwa Y, Hirata T, Sakai N, Yamada H, et al. Tumors at the trigone of the lateral ventricle--clinical analysis of eight cases. Neurol Med Chir (Tokyo) 1990;30:676–684))
((Handa H, Nagasawa S. [Surgery of trigonal tumor] No Shinkei Geka. 1984;12:901–912. )).

====Advantages====
Short trajectory, early identification of the [[anterior choroidal artery]].

====Indications====

Can be the first choice for vascular [[trigone ventricular meningioma]] of the non-dominant hemisphere, fed mainly by the [[anterior choroidal artery]]. 

[[Middle temporal gyrus]] approach when the [[temporal horn]] of the [[lateral ventricle]] is dilated.

The MTG approach is the most widely used procedure for [[trigone]] tumors because of its short trajectory, early identification of the [[anterior choroidal artery]].

====Complications====

However, the MTG incision may result in serious neurological deficits such as visual field defects, language disorder in the dominant hemisphere, or memory disturbance.

Possible mechanism of the postoperative visual field defect is due to the retraction injury of the optic radiation by the standard MTG approach.

====Modification====

The modified trans-MTG approach provides a safe and useful technique for trigonal tumors without postoperative visual field deterioration and affords adequate exposure of the trigonal tumor with a short trajectory
((Choi JW, Jung S, Jung TY, Jang WY, Moon KS, Kim IY. Modified trans-middle
temporal gyrus approach for trigonal tumor to preserve visual field. J Korean
Neurosurg Soc. 2011 Dec;50(6):538-41. doi: 10.3340/jkns.2011.50.6.538. Epub 2011 
Dec 31. PubMed PMID: 22323945; PubMed Central PMCID: PMC3272519.)).

{{::middletemporalgyrusapproach.jpg?200|}}

S: [[Superior temporal gyrus]]

----
The cortical projection of the inferior choroidal point is a reliable landmark to place the corticectomy and reach the temporal horn through a middle temporal gyrus approach
((Frigeri T, Rhoton A, Paglioli E, Azambuja N. Cortical projection of the
inferior choroidal point as a reliable landmark to place the corticectomy and
reach the temporal horn through a middle temporal gyrus approach. Arq
Neuropsiquiatr. 2014 Oct;72(10):777-81. PubMed PMID: 25337730.
)).