RESUMEN
BACKGROUND: Lesions in the temporomesial region can be reached by various approaches: subtemporal, transsylvian, transcortical, interhemispheric parieto-occipital, or supracerebellar transtentorial (SCTT). The choice varies according to the characteristics of the lesion and neighboring structures. CASE DESCRIPTION: In this clinical case, it is presented a 56-year-old man with long-term evolution of drug-resistant epilepsy secondary to a cavernoma in the left parahippocampal gyrus. After assessing the lesion, it was decided a SCTT approach for its resection in a semi-sitting position, to avoid language disorders or visual damage. The surgery was uneventful and the patient did not present epileptic seizures during 6-month follow-up. CONCLUSION: Performing a SCTT is safe and feasible option for resection of lesions located in the basal temporomesial region without causing damage to neighboring structures, especially those located in the middle and posterior two-thirds of temporal region.
RESUMEN
Los cordomas son tumores derivados de los remanentes embrionarios de la notocorda. Son localmente invasivos y en estadios localizados la resección completa es el tratamiento de elección. Presentamos el caso de un varón de 77 años con recidiva de cordoma sacrococcígeo, intervenido por un grupo multidisciplinario formado por cirujanos coloproctólogos, plásticos y neurocirujanos, obteniendo resección en bloque y márgenes negativos. A pesar de que recidivan localmente un 66-75% a los 5 años, la mayoría de los pacientes pueden aumentar su supervivencia si se obtienen márgenes libres. La cirugía debe conseguir una exéresis R0 y minimizar el riesgo de lesión rectal.Chordomas are tumors arising from the embryonic remnants of the notochord. They are locally invasive and in localized stages, complete resection is the treatment of choice. We present the case of a 77-year-old man with recurrent sacrococcygeal chordoma, he was operated by a multidisciplinary group including colorectal-, plastic- and neurosurgeons, obtaining complete en bloc resection with tumor-free margins. Even though 66-75% recur locally in 5 years, most of the patients can increase their survival if margins are tumor-free. The surgery must achieve the R0 exeresis minimizing the risk of rectal injury.