Ht. Wen et al., Microsurgical anatomy of the temporal lobe: Part 1: Mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy, NEUROSURGER, 45(3), 1999, pp. 549-591
OBJECTIVE: We review the anatomy of the mesial temporal lobe region, establ
ishing the relationships among the intraventricular, extraventricular, and
surrounding vascular structures and their angiographic characterization. We
also demonstrate the clinical application of these anatomic landmarks in a
n anatomic temporal lobectomy plus amygdalohippocampectomy.
METHODS: Fifty-two adult cadaveric hemispheres and 12 adult cadaveric heads
were studied, using a magnification ranging from 3x to 40x, after perfusio
n of the arteries and veins with colored latex.
RESULTS: The intraventricular elements are the hippocampus, fimbria, amygda
la, and choroidal fissure; the extraventricular elements are the uncus and
parahippocampal and dentate gyri. The uncus has an anterior segment, an ape
x, and a posterior segment that has an inferior and a posteromedial surface
; the uncus is related medially to cisternal elements and laterally to intr
aventricular elements. The anterior segment is related to the proximal sylv
ian fissure, internal carotid artery, proximal M1 segment of the middle cer
ebral artery, proximal cisternal anterior choroidal artery, and amygdala. T
he apex is related to the oculomotor nerve, uncal recess, and amygdala; the
posteromedial surface is related to the P2A segment of the posterior cereb
ral artery inferiorly, to the distal cisternal anterior choroidal artery su
periorly, and to the head of the hippocampus and amygdala intraventricularl
y. The choroidal fissure is located between the thalamus and fimbria; it be
gins at the inferior choroidal point behind the head of the hippocampus and
constitutes the medial wall of the posterior two-thirds of the temporal ho
rn.
CONCLUSION: Not only is the knowledge of these relations useful to angiogra
phically characterize the mesial temporal region, but it has also proven to
be of extreme value during microsurgeries involving this region.