Anterior Temporal Sulcus: A Reliable Intraoperative Landmark for Accurately Delineating the Superior Limit of Amygdala Resection during Anterior Temporal Lobectomy

摘要

Background: Reliable anatomical landmarks are essential to avoiding injuries to the optic tract, anterior choroidal artery and basal ganglia during anterior temporal lobectomy (ATL). We describe an anatomic landmark, specifically the anterior temporal sulcus (ATS), as a reliable method to define the anterior portion of the endorhinal sulcus and the superior limit of amygdala resection. Methods: A total of 25 consecutive patients undergoing ATL at Rush University Medical Center (RUMC) were identified, and their preoperative brain magnetic resonance imaging (MRI) studies were analyzed. Results: All patients underwent successful ATL without any complication. There was no injury to the optic tract, anterior choroidal artery or basal ganglia using ATS as the landmark for the superior limit of amygdala resection. The ATS was clearly identifiable on coronal preoperative MRI in 48 out of 50 temporal lobes (96%). The ATS was present in all 25 left temporal lobes (100%); 2 of the 25 right temporal lobes had absent ATS (8%). Following the ATS posteriorly on coronal MRI, it led to the endorhinal sulcus and accurately predicted the superior extent of amygdala resection in all 25 patients (48 temporal lobes). Conclusion: The ATS is a reliable anatomical landmark that accurately delineates the superior border of the amygdala during ATL.