Background

Surgical approaches to the temporal region for resection of tumors is challenging due to the anatomic complexity and, in particular, understanding of the critical subcortical white matter. Knowledge of the location of white matter fiber tracts and delicate vessels is essential in preventing complications. As a result, accurate navigation, planning and trajectory are necessary in designing a safe corridor for resection. Case description

We describe here a 49-year-old male with a history of right mesial temporal lobe mass since 2012, with concomitant intractable seizures. MRI showed heterogeneous internal enhancement and multiple internal calcifications, resulting in local mass effect with uncal herniation. DTI showed lateral deviation of the Inferior Longitudinal Fasciculus (ILF) and focally diminished anisotropy of the uncinate. The findings were consistent with a WHO grade I pilocytic astrocytoma. BrightMatter Plan software (Synaptive Medical, Toronto, Canada) was then used to plan a trajectory for insertion of a port system (NICO BrainPath, Indianapolis, IN). Complete resection of the tumor, along with partial temporal lobectomy and amygdalohippocampectomy was performed to treat the seizure focus. Conclusions

To our knowledge, this is the first reported case of a temporal lobectomy and amygdalohippocampectomy using a port technique, in particular, one that demonstrates recovery of the critical (ILF and uncinate fasciculus) subcortical white matter tracts. The combination of real-time, rapid, geometrically accurate 3D-planning of white matter tracts is imperative, especially in conjunction with minimally invasive approaches, thereby offering a new, safer perspective into the approach of temporal lobe lesions.