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<p>Mediobasal temporal lobe (MBTL) intra-axial tumors present a surgical challenge due to their location and proximity to eloquent structures. Surgical resection remains the first-line management of these tumors, especially when they are associated with mass effect and intractable symptoms. The supracerebellar transtentorial (SCTT) approach provides direct access to these tumors via a posterior transtentorial route; however, data regarding its complications and outcomes remain largely limited in the literature.&#xa0;The authors searched several databases for studies that reported clinical outcomes and complications from the SCTT approach for intra-axial MBTL tumors. Patient and tumor data were retrieved and analyzed. Tumor location was classified into seven categories per standard coronal planes: anterior, middle, posterior, anterior-middle, middle-posterior, entire, and unspecified. Twelve studies comprising sixty-eight patients (median age: 33.5 years [IQR:20–50], 55.6% females) with a median tumor size of 5.5 cm<sup>3</sup> (IQR:2.8–10.8) were included. Tumors demonstrated left-sided predominance (73.7%) and were mostly gliomas (63%). The SCTT approach was performed in a semi-sitting position in 51 patients. Gross total resection (GTR) was achieved in 80.3% of cases, and 94.1% of patients remained recurrence free at median follow-up of 10 months (IQR:3–28). Seizure freedom was achieved in 90.7% of patients, and 7.4% experienced improvement. Complications were observed in 15 patients, most commonly new visual deficits (<i>n</i> = 6) and transient hemiparesis (<i>n</i> = 5). Tumor location along the anterior-posterior axis predicted neurological outcomes (<i>p</i> = 0.028). Among patients with specified tumor location, neurological improvements/stability occurred in posterior MBTL tumors (18% improved, 82% stable), and worsened outcomes occurred in tumors with anterior MBTL involvement (anterior, anterior-middle, entire).&#xa0;In this pooled analysis, the SCTT approach for the resection of posterior and middle MBTL tumors was associated with favorable seizure and neurological outcomes and less complications when compared with tumors with anterior MBTL involvement.</p>

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Complications and outcomes after supracerebellar transtentorial approach for mediobasal temporal lobe intra-axial tumors: A systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月7日

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  • Brock J. Gjesdal,
  • Andrew Hoang,
  • Adway Gopakumar,
  • Ibrahem Albalkhi,
  • Basel Musmar,
  • Arka N. Mallela,
  • Mansour Mathkour,
  • Nimer Adeeb,
  • Mohamed A. Labib,
  • Amir R. Dehdashti,
  • Constantinos G. Hadjipanayis,
  • William T. Couldwell,
  • Deanna Sasaki-Adams,
  • Jacques J. Morcos,
  • Hussam Abou-Al-Shaar

摘要

Mediobasal temporal lobe (MBTL) intra-axial tumors present a surgical challenge due to their location and proximity to eloquent structures. Surgical resection remains the first-line management of these tumors, especially when they are associated with mass effect and intractable symptoms. The supracerebellar transtentorial (SCTT) approach provides direct access to these tumors via a posterior transtentorial route; however, data regarding its complications and outcomes remain largely limited in the literature. The authors searched several databases for studies that reported clinical outcomes and complications from the SCTT approach for intra-axial MBTL tumors. Patient and tumor data were retrieved and analyzed. Tumor location was classified into seven categories per standard coronal planes: anterior, middle, posterior, anterior-middle, middle-posterior, entire, and unspecified. Twelve studies comprising sixty-eight patients (median age: 33.5 years [IQR:20–50], 55.6% females) with a median tumor size of 5.5 cm3 (IQR:2.8–10.8) were included. Tumors demonstrated left-sided predominance (73.7%) and were mostly gliomas (63%). The SCTT approach was performed in a semi-sitting position in 51 patients. Gross total resection (GTR) was achieved in 80.3% of cases, and 94.1% of patients remained recurrence free at median follow-up of 10 months (IQR:3–28). Seizure freedom was achieved in 90.7% of patients, and 7.4% experienced improvement. Complications were observed in 15 patients, most commonly new visual deficits (n = 6) and transient hemiparesis (n = 5). Tumor location along the anterior-posterior axis predicted neurological outcomes (p = 0.028). Among patients with specified tumor location, neurological improvements/stability occurred in posterior MBTL tumors (18% improved, 82% stable), and worsened outcomes occurred in tumors with anterior MBTL involvement (anterior, anterior-middle, entire). In this pooled analysis, the SCTT approach for the resection of posterior and middle MBTL tumors was associated with favorable seizure and neurological outcomes and less complications when compared with tumors with anterior MBTL involvement.