Microsurgery of the Temporo-Medial Region

The differentiation of the temporal lobe into a lateral neocortical and a medial allocortical region is supported by developmental anatomical and clinical evidence. Although this view of a dual temporal lobe is generally accepted by neurosurgeons dealing with functional surgery it still receives little attention by those approaching structural abnormalities located or extending into the medio-basal region. Consequently the characterization of the temporo-medial area as a distinct surgical region is still lacking. The major object of this study is to analyse the medial part of the temporal lobe as a distinct surgical region and to integrate the microsurgical and physiological aspects into a concept applicable to the several types of temporo-medial lesion. The study includes five sections. The first section is devoted to the morphological aspects; the second and the third sections present a simplified clinical approach to temporo-medial lesions and analyse the ancillary investigations which are indispensable for characterizing their structural and functional features. The fourth section deals with the surgical aspects of temporo-medial lesions and especially with the selection of the optimal approach in regard to the location of a given process and to the extent of the functional changes. The last section is devoted to commentaries concerning the neuropathological aspects and the outcome of surgery in the temporo-medial region.