Using the zygomatic root as a reference point in temporal lobe surgery
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CLINICAL ARTICLE - NEUROSURGICAL ANATOMY
Using the zygomatic root as a reference point in temporal lobe surgery J. M. Beckman & F. L. Vale
Received: 10 July 2013 / Accepted: 5 September 2013 / Published online: 20 September 2013 # Springer-Verlag Wien 2013
Abstract Background The zygomatic root (ZR) is an anatomic landmark routinely identified during cranial procedures. Traditionally, it has been used for identification of structures other than temporal lobe anatomy. The aim of this study was to define the structural relationship between the ZR and temporal lobe anatomy and provide a consistent landmark to guide surgical dissection. To our knowledge, there have been no studies demonstrating this relationship. Methods Eighteen DICOM series were analyzed. 2 mm axial MRI slices were reconstructed with the x-axis centered along the zygoma. The posterior point of the ZR that marks the beginning of the groove between the zygoma and temporal bone was identified on all images. Several measures were taken to quantify the relationship of the zygomatic root to surgical landmarks used during temporal lobe surgery. Results The inferior temporal gyrus was always found just medial to the ZR. The mean distance between the ZR and temporal pole was 2.75 cm on the right and 2.78 cm on the left. The tip of the temporal horn was located on average 2.4 cm (left) and 2.31 cm (right) medial to the ZR. The tip of the temporal horn was found to be an average distance of 1 mm (left and right) posterior and 1.34 cm (left and right) superior to the ZR. All distances were measured orthogonally for each of the x, y, and z axes. Conclusion The zygomatic root is an easily identifiable and consistent bony landmark that can serve as an adjuvant to neuronavigation for identification of temporal lobe surgical anatomy. J. M. Beckman : F. L. Vale (*) Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA e-mail: [email protected]
Keywords Zygomatic root . Temporal lobe . Epilepsy . Middle fossa . Zygoma . Temporal horn
Introduction The zygomatic root (ZR) is an anatomic landmark routinely identified during cranial procedures. It is used to help identify structures such as the frontalis branch of the facial nerve, the floor of the middle fossa, and in conjunction with the inion, the transverse sinus [4, 5, 13]. The consistent relationship of surface structures to internal anatomy has been proven repeatedly and is the basic foundation for all of our surgical approaches. The advent of surgical navigation systems has further expanded our ability to identify internal structures and even allowed for limited access trajectories. However, navigation is not without flaws and accuracy can be compromised by many factors, including poor registration or shifts within the cranium during access. A long, narrow operative field and complex anatomy can lead to spatial disorientation and difficulty in locating routine anatomic landmarks even with the assistance of navigation. We therefore believe that intraoperative navigation should
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