gms | German Medical Science

Objective: To describe different types of temporo-medio-basal tumors (TMB), the approaches, complications and outcomes in a retrospective series.

Methods: 235 patients with TMB-tumors were identified all with preoperative MRI. Symptoms, approaches, technical problems, surgical techniques and outcomes are described.

Results: 235 patients were identified, mean age 35 years, male to female ratio 131/104, left/right 124/112. Seizures were leading symptoms in 214 patients. 38 patients had had prior outside surgery. A tumor classification based on tumor size and location was used. 137 tumors were located anteriorly, 62 posteriorly. 24% of tumors were no bigger than 2 cm, 65% were no bigger than 3.5 cm. The largest tumor groups were astrocytomas (37,9%), gangliogliomas (29.8%), DNTs (11%). 76.2% of all tumors were benign, more mesially located tumors were more frequently benign, as were smaller tumors. For anteriorly located tumors in 71% of cases either a transsylvian exposure or anterior lobectomy was used. The posterior group was mostly removed through a subtemporal approach (75%). Overall subtemporal approaches were used in 19%, transcortical in 6%, transsylvian in 28% and partial lobe resections in 38%. Most frequent neurological complications were transient: dysphasia 4,2%, hemiparesis 5%, and oculomotor disturbance 2,5%. Permanent neurological complications were rare (2.5%) except for a 36% incidence of quadrantanopia and 9 cases of new hemianopia.

Conclusions: This series differs considerably from Yasargil’s limbic tumor series: Many tumors are small, most are benign, and a variety of approaches other than transsylvian were used. These tumors can be operated with a relative degree of safety. Although transient neurological deterioration is not infrequent and certain visual field defects appear unavoidable, it could be demonstrated that tumors in this difficult area can now be operated on successfully.