Anatomical aspects, technical nuances, and a case series of the resection of the inferior temporal gyrus as a strategy to access the basal surface of the temporal lobe and the lateral incisural space.

Abstract

Background: Pathologies of the basal surface of the temporal lobe (TL) and the lateral incisural space (IS) commonly present microsurgical challenges. Since the inferior temporal gyrus (ITG) is part of both the lateral and the basal surfaces, it has a close relationship with the basal surface of the TL and lacks major white matter tracts, reducing the risk of eloquence. This study aims to describe the technique of ITG resection, its applications in four surgical cases, and the relevant anatomical aspects.

Methods: An anatomical review of the TL and the IS was performed. Anatomical pieces fixed using Klingler's technique and alcohol-fixed, silicone-injected cadaver heads were used to demonstrate landmarks and relationships. The step-by-step surgical technique is described, with four case reports exemplifying its application.

Results: The patients reported no visual field impairments, memory complaints, or neurological complications. The resection of the ITG increases the working space and wider the surgical corridor, allowing access to medial temporal basal structures and the tentorial notch.

Conclusion: The resection of the ITG represents a useful technique to reach the basal surface of the TL and the lateral IS since it avoids excessive retraction of the TL which may cause vessel injury, mainly to the vein of Labbé. Furthermore, it provides relaxation of the vein of Labbé when venous congestion is present. However, more studies are necessary to demonstrate short and long-term outcomes of the resection of the ITG.