Assessing the connectional anatomy of superior and lateral surgical approaches for medial temporal lobe epilepsy

Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus

“…ASTA can provide access to the petroclival region and ventral brainstem and may be preferred for lesions extending to the upper petroclival region, ventrolateral pontomedullary junction, and the lower half of the pons. 5,[12][13][14][15][16] RSMTA and ASTA have been subject to a few comparisons, because the target surgical area and the area of bone removal resemble in both approaches. 7,15,17 This study proceeds on the assumption that the initial opening of the internal acoustic meatus (IAM) prior to RSMTA or ASTA would provide different surgical perspectives via separate avenues.…”

“…ASTA can provide access to the petroclival region and ventral brainstem and may be preferred for lesions extending to the upper petroclival region, ventrolateral pontomedullary junction, and the lower half of the pons. 5,12-16…”

Letter: Anterior Nucleus of the Thalamus Deep Brain Stimulation With Concomitant Vagus Nerve Stimulation for Drug-Resistant Epilepsy

“…Through their associated nuclei, the afferent fibers of the vagus nerve, which receives peripheral information through VNS, can send projections to various parts of the brain and can alter functional connectivity and the synaptic activities in the hypothalamus and the anterior thalamic nucleus through the mammillotegmental tract, mammillary peduncle, and mammillothalamic tract. [2][3][4][5][6][7][8] Given the functional anatomic network in the central nervous system and considering that the anticonvulsant activity of VNS may occur because of decreased hippocampal activity and changes in the thalamic synaptic activities (possibly through increased GABAergic signaling), it could be possible that the antiepileptic effects of VNS and ANT-DBS are not independent of each other but, rather, are complementary.…”

“…Reviewing past anatomic studies, especially those related to the functional anatomy of white matter, may help better understand the basics of clinical observations. [2][3][4] Previous anatomic reports suggested that the mechanism of action of the ANT-DBS and VNS may follow the same anatomic paths. 2,[5][6][7] One of the most compelling indications of this is the close anatomic relationship that exists between the vagal nuclei and the Gudden nucleus of the mammillotegmental tract in the brainstem and, consequently, the connections of the anterior thalamic nucleus through the mammillothalamic tract.…”