Ultrastructural investigation of synaptic alterations in the rat hippocampus after irradiation and hyperthermia.

This study aimed to investigate ultrastructural synaptic alterations in rat hippocampus after in utero exposure to irradiation (IR) and postnatal exposure to hyperthermia (HT). There were four groups in each of the time points (3rd and 6th months). IR group: Pregnant rats were exposed to radiation on the 17th gestational day. HT group: Hyperthermia was applied to the rat pups on the 10th day after their birth. IR+HT group: Both IR and HT were applied at the same time periods. Control group: No IR or HT was applied. Rat pups were sacrificed after 3 and 6 months. Thin sections from the dentate gyrus (DG) and the CA3 of hippocampus were evaluated for synapse numbers by electron microscopy. Synapses were counted, and statistical analysis was performed. Abnormalities in myelin sheath, mossy terminals and neuropil were observed in the CA3 and DG of all groups. The synapses in the CA3 region were significantly increased in the IR-3rd month, IR-6th month, and IR+HT-3rd month groups vs control group. Synapses were significantly increased in the DG of HT-3rd month group. A trend for an increase in synapse numbers was seen in the CA3 and DG. Increased number of synapses in the rat hippocampus may be due to mossy fiber sprouting, possibly caused by in utero irradiation and/or postnatal hyperthermia.

Clinical outcomes of symptomatic thoracic disk herniations treated surgically through minimally invasive lateral transthoracic approach.

Although symptomatic thoracic disk herniation (TDH) is relatively rare, its treatment is quite difficult. Our aim is to present the outcomes and complications in patients with thoracic disk herniation treated with minimally invasive lateral transthoracic approach (LTTA). Fifty-nine consecutive patients with 69 symptomatic disk herniations that underwent minimally invasive LTTA to treat TDH between 2007 and 2016 were enrolled. Medical records were reviewed retrospectively. The numbers of TDH were as follows: 41 central, 10 paracentral, and 18 both central and paracentral. The number of calcified disk herniations was found to be 32. No patient developed neurological deficit. Postoperative neurological improvement occurred in 39 (90.7%) of 43 patients with myelopathy. Preoperative VAS scores, ODI scores, and SF-36 scores improved at the follow-up, respectively. Mean blood loss, hospitalization period, and follow-up period were found to be 391.2 mL, 4.7 days, and 60 months; respectively. The following complications were observed: dural tear (five patients), intercostal neuralgia (three patients), rib fracture (one patient), pleural effusion requiring chest tube (two patients), hydropneumothorax requiring chest tube (one patient), small pneumothorax (one patient), atelectasis (one patient), pulmonary embolism (one patient), and pneumonia (one patient). Minimally invasive LTTA not only minimizes the manipulation of the thecal sac decreasing the risk for neurological injury compared to traditional posterior methods but also significantly decreases the pulmonary complications associated with traditional open procedures. Based on the authors' experience, anterior approach should be preferred especially in calcified central disk herniations regardless of surgeon's experience.

Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients.

Thoracic disc herniations are associated with serious neurological consequences if not treated appropriately. Although a number of techniques have been described, there is no consensus about the best surgical approach. In this study, the authors report their experience in the operative management of patients with thoracic disc herniations using minimally invasive lateral transthoracic trans/retropleural approach. A series of 33 consecutive patients with thoracic disc herniations who underwent anterior spinal cord decompression followed by instrumented fusion through lateral approach is being reported. Demographic and radiographic data, perioperative complications, and clinical outcomes were reviewed. Forty disc levels in 33 patients (18F/15M; mean age, 52.9) were treated. Twenty-three patients presented with myelopathy (69 %), 31 had radiculopathy (94 %), and 31 had axial pain (94 %). Among patients with myelopathy, 14 (42.4 %) had bladder and/or bowel dysfunction. In the last eight cases (24 %), the approach was retropleural instead of transpleural. Patients were followed up for 18.2 months on average. The mean length of hospital stay was 5 days. None of the patients developed neurological deterioration postoperatively. Among 23 patients who had myelopathy signs, 21 (91 %) had improved postoperatively. The mean preoperative visual analog scale pain score, Oswestry Disability Index score, SF-36 PCS, and mental component summary scores were 7.5, 42.4, 29.6, and 37.5 which improved to 3.5, 33.2, 35.5, and 52.6, respectively. Perioperative complications occurred in six patients (18.1 %), all of which resolved uneventfully. Minimally invasive lateral transthoracic trans/retropleural approach is a safe and efficacious technique for achieving adequate decompression in thoracic disc herniations in a less invasive manner than conventional approaches.

Transpedicular Corpectomy and Anterior Column Reconstruction for the Treatment of Traumatic Thoracolumbar Fractures.

AIM: To retrospectively analyze the results obtained from the posterior-only approach in non-pathological traumatic thoracolumbar body fractures with spinal cord compression. MATERIAL AND METHODS: A total of 17 patients with traumatic non-pathological thoracolumbar fractures were included in the study. Demographic details include preoperative data such as neurological status, deformity, pain scores, and radiology; intraoperative data such as blood loss, duration of surgery, and complications, and postoperative data including the neurologic status; the duration of hospital stay, pain scores, and deformity correction were analyzed. RESULTS: Among the 17 patients, 8 were in ASIA A, 9 had incomplete neurologic deficits (ASIA C - D), and none was neurologically intact (ASIA E) preoperatively. All patients had TLICS scores > 4 and were treated surgically. The mean TLICS score was 7.31. Although no worsening was detected in the neurological images of the patients during the postoperative period, neurological improvement of at least one ASIA grade was detected in 13 patients. However, it was found that the neurological functions remained the same in the 4 patients. With significant improvement, the mean preoperative VAS score was 8.2, while the mean postoperative VAS score was 3.3. In addition, satisfactory outcomes were obtained in radiological examinations, both in terms of kyphotic deformity and vertebral body collapse. CONCLUSION: Traumatic thoracolumbar fractures can be effectively fixed with the posterior-only approach and the transpedicular route. One of the most significant advantages of this procedure is that peripheral decompression, reduction, anterior column reconstruction, and instrumentation all can be performed simultaneously in the same session.

Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture.

PURPOSE: The surgical treatment of spinal metastases is mostly palliative in nature and focuses on improving the quality of life of patients. The posterior transpedicular surgical approach provides circumferential 360° decompression, allows reconstruction and stabilisation to be achieved in a single session and can be performed using an open, mini-open or minimally invasive approach. We present and discuss the surgical techniques and outcomes for patients with single-level metastatic spinal disease and in poor general condition who underwent surgery via the posterior-only transpedicular corpectomy approach and reconstruction with expandable corpectomy cages. METHODS: Patients with a single level thoracolumbar metastatic disease (T3-L5) and a Karnofsky score of ≤70, who underwent a complete posterior transpedicular corpectomy with expandable cage reconstruction of the anterior spinal column were retrospectively reviewed. Patients' demographics, SINS, modified Tokuhashi scores as well as preoperative and postoperative ASIA scale, Karnofsky scores, VAS scores and vertebral height/Cobb angle values were analysed. RESULTS: A total of 44 patients (24 M/20 F) (mean age 53.25±21.26 years) met the inclusion criteria. The modified Tokuhashi scores were as follows: score 0-8, 5 (11.4%) patients; score 9-11, 14 (31.8%) patients; and score 12-15, 25 (56.8%) patients. There were significant improvements in the postoperative VAS scores (mean 7.7-2.9), Karnofsky scores (mean 63.3-79.6) as well as the Cobb angles (18.6-12.8°) and vertebral height. Thirtyfive patients showed improved neurological function by at least one ASIA grade, whereas 9 showed no improvement during the postoperative period. CONCLUSIONS: This technique, which has a low complication rate and a short recovery time, can help achieve satisfactory results even in patients with poor metabolic profiles and Karnofsky scores in the preoperative period. Further clinical studies with large patient groups are warranted to confirm the results of this study.

The expression of astroglial glutamate transporters in patients with focal cortical dysplasia: an immunohistochemical study.

PURPOSE: An abnormal increase in the extracellular glutamate is thought to play a crucial role in the initiation, spread, and maintenance of seizure activity.In normal conditions, the majority of this excess glutamate is cleared via glial glutamate transporters (EAAT-1 and EAAT-2). We aimed to examine the immunohistochemical expression of these transporters in the dysplastic tissues of patients with focal cortical dysplasia (FCD). METHODS: The parafin-embedded dysplastic tissues of 33 patients who were operated on due to medically intractable epilepsy and histopathologically diagnosed with FCD between 2001 and 2006 were stained immunohistochemically with appropriate antibodies, and the distribution and intensity of immunoreactivity (IR) of EAAT-1 and EAAT-2 were examined.The findings were compared with the histologically normal tissues of five patients who underwent temporal lobectomy for epilepsy surgery and 10 fresh postmortem cases. RESULTS: In the majority of the patients, the EAAT-1 and EAAT-2 IR were decreased, their astrocytic expression were lower, and the pattern of distribution were more diffused when compared to the control groups.Analyzing these findings according to the types of FCD revealed that as the severity of the dysplasia increased, the IR and astrocytic expression of both transporters are decreased and their distribution tend to be more "diffused." CONCLUSION: The results of this study suggest a relationship between the decreased glutamate transporter expressions in dysplastic tissues which,in turn, may cause increased extracellular concentrations of glutamate and FCD pathophysiology.Further studies with larger patient populations,investigating the expression of glutamate transporters at mRNA and protein levels, are required to clarify their roles in the pathophysiology of FCD.

Intraosseous meningioma: a rare tumor reconstructed with porous polyethylene.

A 45-year-old woman described the pain and the swelling at the left frontoparietal region. No significant findings were noted on physical examination, except a heterogeneous palpable lesion at the described region. Computed tomographic scan revealed an expansive bone lesion with homogeneous density, whereas magnetic resonance imaging revealed similar findings with no contrast enhancement. The lesion was totally resected, and cranioplasty with a porous polyethylene sheet (Medpor Biomaterial; Porex Surgical, Newnan, GA) was achieved. Histopathologic examination revealed an intraosseous meningioma. As far as we know, this case is the first case, in which total excision of the interosseous meningioma is followed by reconstruction with Medpor.

C6-T1 Intradural Extramedullary Ventral Meningeal Melanocytoma Resected Via Anterior Corpectomy with Reconstruction.

BACKGROUND: Melanocytic lesions of the nervous system are thought to arise from leptomeningeal melanocytes, which are derived from neural crest and include diffuse melanocytosis, melanocytomas, and malignant melanomas. Meningeal melanocytomas are extremely rare benign lesions. The usual treatment of intradural extramedullary melanocytomas involves surgical removal through a posterior approach using a laminectomy or laminotomy. CASE DESCRIPTION: We present a 30-year-old female harboring a C6-T1 ventrally located intradural extramedullary lesion compressing the cord anteriorly. The lesion was totally resected via an anterior approach with oblique corpectomy even if the usual treatment involves surgical removal through a posterior approach using a laminectomy or laminotomy. CONCLUSIONS: There is no evidence of recurrence at 4-year follow-up records of the patient. We discuss the surgical approach of these rare lesions.

Surgical management of spinal intramedullary tumors: Ten-year experience in a single institution.

Despite their rare occurrence, intramedullary spinal cord tumors can cause considerable morbidity and mortality without treatment. Timing of surgery, extent of resection and selection of favorable treatment option are important considerations for a good surgical outcome. In this clinical study, we report our patient series and convey our treatment strategy. We retrospectively reviewed 91 patients with primary intramedullary spinal cord tumors who underwent microsurgical resection at our institution between 2008 and 2018. Data were collected consisting of age, sex, location and histology of tumor, extent of resection, presenting symptoms and neurological outcomes. Modified McCormick Scale was used to assess neurological status of patients. 47 female and 44 male patients were followed-up for a mean period of 35.7 months. The most frequent pathological diagnosis was ependymoma in 56 patients, followed by astrocytoma in 21 and hemangioblastoma in 5 patients. The rest of the tumors consisted of 3 cavernomas, 3 mature cystic teratomas, 2 PNET, one epidermoid tumor. Gross total resection was achieved in 67 patients, while subtotal resection and biopsy was performed in 15 and 9 respectively. The most commonly involved localization was cervical (n = 39), followed by thoracic region (n = 24). Despite immediate postoperative worsening of neurological status, a great number of patients improved at the last follow-up. Gross total resection remains the primary goal of treatment while adjuvant radiation and/or chemotherapy may be alternative options for high grade tumors. Preoperative neurological status was the most important and the strongest predictor of functional outcome.

Hearing preserved traumatic delayed facial nerve paralysis without temporal bone fracture: neurosurgical perspective and experience in the management of 25 cases.

BACKGROUND: Delayed FNP due to HT is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. METHODS: Twenty-five patients with delayed traumatic FNP without TBF, who had serviceable hearing, were included in our study. Thirteen patients underwent surgical decompression, whereas 12 were managed medically depending on the ENoG findings, which were obtained within the first 3 weeks after the onset of the facial paralysis. Pre- and postmanagement evaluation of the FN function was graded according to HB grading scale. RESULTS: The mean follow-up period was 6.5 +/- 4.06 years. Complete or nearly complete recovery of FN function had occurred in 66.6% and 76.9% in medically and surgically treated groups, respectively. Most of the patients showed good outcome, and the presented data supports that the choice of treatment in patients with hearing preserved delayed traumatic FNP without TBF depends mainly on the ENoG findings. CONCLUSIONS: Although timing of surgery in traumatic delayed FNP remains to be elucidated, we think that surgical exploration should be considered if serial ENoG demonstrates more than 90% nerve degeneration.

Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective.

BACKGROUND: The purpose of this study was to call attention to the subtemporal approach directed through the petrous apex to the IAM. We studied the microsurgical anatomy of the middle floor to delineate a reliable angle between the GSPN and the IAM to precisely localize and expose the IAM from above. A new technique for the elevation of middle fossa floor in an anterior-to-posterior direction has also been examined in cadaveric dissections and performed in surgery. METHODS: The microsurgical anatomy of the middle fossa floor was studied in 10 adult cadaveric heads (20 sides) after meatal drilling on the middle fossa. Five latex-injected specimens were dissected in a stepwise manner to further define the microsurgical anatomy of the middle fossa approach. The middle fossa approach is illustrated in a patient for the decompression of the facial nerve to demonstrate the surgical technique and limitations of bone removal. RESULTS: Elevation of middle fossa dura in an anterior-to-posterior direction leads to early identification of the GSPN, where the nerve passes under V3. The most reliable and easily appreciated angle to be used in localizing the IAM is between the IAM and the long axis of the GSPN, which is approximately 61 degrees . Beginning drilling the meatus medially at the petrous ridge is safer than beginning laterally, where the facial and vestibulocochlear nerves become more superficial. The cochlea anteromedially, vestibule posterolaterally, and superior semicircular canal posteriorly significantly limit the bone removal at the lateral part of the IAM. CONCLUSIONS: The surgical technique for the middle fossa approach which includes an anterior-to-posterior elevation of middle fossa dura starting from the foramen ovale and uses the angle between the IAM and the long axis of the GSPN to localize the meatus from above may be an alternative to previously proposed surgical methods.

Supratentorial high grade astroblastoma: report of two cases and review of the literature.

Astroblastoma is a rare glial tumor with uncertain histopathological origin and unpredictable clinical behavior. In this report, the authors present two cases of high grade intracerebral astroblastomas. Both tumors occurred in children as supratentorial, well-circumscribed, peripheral masses. The lesions differed radigraphically; one contained a huge cystic component and heterogeneously enhancing mural nodule while the other appeared as a prominently contrastenhancing solid mass lesion. Both patients were treated with surgery and postoperative radiotherapy. They were followed-up long-term and no recurrence of the tumor was detected in either case. We also discussed the radiological and histological characteristics with prognostic features.

Endoscopic endonasal transsphenoidal approach to the sellar region: results of endoscopic dissection on 30 cadavers.

AIM: To recognize the endoscopic anatomy of the surgical corridor along the nasal cavity, sphenoidal sinus and the sellar area to delineate the pure endoscopic endonasal transsphenoidal approach (EETSA) to the region of the pituitary gland. MATERIAL AND METHODS: The endoscopic anatomy of the nasal cavity, sphenoid sinus and the sellar region was studied in 30 fresh cadavers (mean age 42.1 / range 18-66) and dissections were performed in a stepwise manner to simulate EETSA to the sellar region. RESULTS: The sphenoid ostium, located 14.9 mm superior to the choana, was identified at the midpoint between the nasal septum and the superior turbinate in 23 specimens. The shape of the sphenoid ostium was linear (35%), fusiform (30%), oval(22%) or circular (13%). The mean width of the pituitary gland was 14.3 mm and the average minimum distance between the internal carotid arteries on both sides ranged between 13 to 22 mm. Following total hypophysectomy in 12 specimens, the width and length of diaphragma sellae was measured 10.83 and 5.83 mms respectively. CONCLUSION: This study documents that variations are common in nasal, sphenoidal and sellar phases of the trans-sphenoidal approach. Detailed knowledge of the basic anatomical relationships through the view of the endoscope and performing endoscopic dissections in large number of specimens will facilitate the endoscopic surgical procedures and decrease the rate of surgical complications.

Intraoperative Neuromonitoring in Surgery of Cauda Equina and Conus Medullaris Tumors.

AIM: To demonstrate the value of special intraoperative neuromonitoring techniques for cauda equina and conus medullaris tumors (CECMT) by describing standard methods used at our center. MATERIAL AND METHODS: Neurophysiological records were retrospectively reviewed for 16 patients (eight females and eight males; age range: 27â€"60 years) who underwent surgery for CECMT at our department between 2016 and 2018. RESULTS: Motor and/or sensorial deficits were preoperatively identified in 10 patients; no patients had bladder or sexual dysfunction. Motor evoked potential (MEP) loss occurred in seven patients with full or partial recovery. No changes were seen in pudendal somatosensory evoked potential (SEP) or bulbocavernosus reflex (BCR), and morphological deterioration and amplitude loss of tibial SEPs were present in four patients. Postoperatively, no new neurological deficits and/or bladder and sexual dysfunction were present. CONCLUSION: Pudendal SEP and BCR are useful tests for monitoring CECMT surgeries. BCR is an easily obtainable modality for preserving sacral functions and recommended as a primary monitoring modality in conjunction with traditional neurophysiological techniques during CECMT surgery.

Added Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Response to Somatostatin Analogs in Acromegaly Patients.

AIM: To investigate the added value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) sequences in predicting somatostatin analog (SSA) responses in patients with acromegaly. MATERIAL AND METHODS: This study included 55 active acromegaly patients with macroadenoma. Mean and maximum signal intensities were measured using region of interests in T2-weighted (T2W) and DCE-MRI sequences. Semi-quantitative values indicating relative signal intensity ratios and contrast-enhanced kinetics were obtained. Bivariate and multivariate analyses were used to determine whether the pathological granulation pattern of adenomas (dense versus others) was associated with patients' demographic variables and semi-quantitative MRI parameters. RESULTS: Three parameters formed the logistic model, x2(3)=23.278, p < 0.0001: age (odds ratio [OR]=1.08), hypointensity of adenomas in T2W images (OR=15.45), and high maximum enhancement ratio in the second interval (ER2max) values (OR=2195.74). The overall accuracy of this model was 85.45% with an area under the curve of 0.880. Sensitivity, specificity, positive predictive, and negative predictive values of the model were 68.75%, 92.31%, 78.58%, and 87.8%, respectively. CONCLUSION: In patients with newly diagnosed acromegaly, the model created based on the relative T2W signal intensity, patient's age, and ER2 < submax parameter from DCE-MRI sequences might be used to more accurately predict SSA responses.

Spinal Vascular Malformations: Treatment and Outcome.

BACKGROUND: Vascular malformations of the spinal cord are a rare and complex clinical entity and can lead to severe morbidity with progressive spinal cord symptoms if not treated properly. In early stages, the disease is characterized by slowly progressive, nonspecific symptoms, such as gait disturbance, paresthesia, diffuse sensory symptoms, and radicular pain; in the late stages, bowel and bladder incontinence, erectile dysfunction, and urinary retention may develop. In recent decades, understanding and treatment of spinal vascular malformations have improved with the evolution of diagnostic tools and treatment modalities; however, it is still difficult to manage these cases because of the complexity of the pathology. The aims of this study were to present the long-term outcomes of our patients and to discuss the optimal management strategies. METHODS: We reviewed the records of 78 patients with spinal vascular malformations and performed a retrospective, single-center case series evaluating initial occlusion, recanalization, retreatment, and neurologic status of patients with dural arteriovenous fistulas, perimedullary arteriovenous fistulas, arteriovenous malformations, and extradural arteriovenous fistulas who had undergone embolization and/or surgery. RESULTS: No mortality was observed. Complete obliteration was achieved in 76 patients (97.4%). CONCLUSIONS: Both endovascular and surgical treatment of spinal vascular malformations resulted in significant long-term recovery from myelopathic symptoms and improvement in quality of life for most patients.

Surgical Management of Thoracic Disc Herniation: Anterior vs Posterior Approach.

AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. MATERIAL AND METHODS: A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. RESULTS: The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p > 0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p < 0.05). CONCLUSION: The current study showed that higher rates of major complications in central and calcified paracentral TDHs are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.

Management of Cushing's disease using cavernous sinus sampling: effectiveness in tumor lateralization.

OBJECTIVE: The aim of this study was to determine the accuracy of bilateral cavernous sinus sampling (CSS) in preoperative tumor lateralization (right/left) within the pituitary in patients with Cushing's disease (CD). PATIENTS AND METHODS: The study consisted of 26 consecutive patients who had undergone CSS followed by transsphenoidal surgery (TS) for CD between 2000 and 2006 at our institution. The magnetic resonance imaging (MRI) of the selected patients either revealed a normal pituitary or a lesion

Intracranial hypotension following scoliosis surgery: dural penetration of a thoracic pedicle screw.

The authors report on a 14 years old female with intracranial hypotension who had a history of spinal instrumentation surgery for scoliosis 3 months prior to her admission. She had been diagnosed with migraine in a neurology clinic and was under medical therapy when presented. During the investigation process, a right thoracic pedicle screw, which was penetrating and transversing the dura mater at the T3-T4 level was identified. The diagnosis and management of such a case is discussed. Knowledge of this entity is of extreme importance to spine surgeons, in order to prevent delayed diagnosis and possible complications.

Epidermoid tumour within the collateral sulcus: a rare location and atypical presentation.

Epidermoid tumours (ETs) are uncommon benign lesions that may grow by spreading in the subarachnoid space of the basal cisterns and expanding to conform to the shape of specific sulci and fissures. A temporobasal location is very rare, and there have been no reports regarding single sulcus involvement of ETs. We describe the case of an ET located on the basal surface of the temporal lobe, predominantly within the collateral sulcus, which separates the parahippocampal gyrus medially from the fusiform gyrus laterally. We report the case of a 25-year-old woman with complex visual hallucinations. MRI of the brain revealed a right temporobasal mass lesion, hypointense on T(1)-weighted and hyperintense on T(2)-weighted images, with minimal contrast enhancement, on the basal surface of the temporal lobe. Right-sided anterior temporal lobectomy, along with microsurgical removal of the collateral sulcus ET were performed with consequent resection of mesial temporal structures (the region of the hippocampus, parahippocampal gyrus, and amygdala). It is important to consider ETs when treating lesions on the basal temporal lobe, since the inferior surface of the temporal lobe, more specifically the collateral sulcus, may be a convenient space for ETs to localize. Total surgical resection should be the goal in these cases; however, the surgical approach may be tailored to include the resection of mesial temporal lobe structures when seizure is the predominant presenting symptom.