Clinical and Imaging Evaluation of Transuncus Selective Amygdalohippocampectomy

Ghizoni, Enrico; Matias, Roger Neves; Lieber, Stefan; Campos, Brunno M.; Yasuda, Clarissa Lin; Souza, João Paulo Sant Ana Santos de; Pereira, Pâmela Castro; Filho, Augusto Celso Scarparo Amato; Joaquim, Andrei Fernandes; Lopes, Tátila Martins; Tedeschi, Hélder; Cendes, Fernando

doi:10.1016/j.wneu.2016.11.056

Cited by 10 publications

(17 citation statements)

References 19 publications

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“…34 Following this anatomical paradigm change and trying to validate this new anatomical proposition for an anteromedial approach through the uncus to reach the temporal horn, we started a prospective analysis of a series of patients who underwent TU SAH. 14 The objective was to check if the TU approach was more effective in protecting the TS and its contents than the traditional TI approach. However, our results showed a high incidence of postoperative TP atrophy (69.6% in the TU approach and 100% in the TI approach); therefore, we decided to analyze with advanced neuroimaging techniques the remaining TP.…”

Section: Discussionmentioning

confidence: 99%

“…1C and D). 14 The main proposal for, or change in, this approach was to reach the temporal horn while avoiding the TS and ORs. The approach was proposed by Coppens et al 9 and Choi et al 6 in elegant anatomical studies and has even been used by Yaşargil in his latest technical description.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…15,33 While some surgeons perform selective approaches to try to avoid injuries to the temporal neocortex, temporal stem (TS), and optic radiations (ORs), 5,6 our group observed a high incidence of temporal pole (TP) atrophy on late postoperative MRI in patients who had undergone transsylvian SAH. 14 This observation raises the question of whether transsylvian SAH is as selective as anatomically proposed. Therefore, in this paper, we aimed to study through advanced neuroimaging techniques any late postoperative effects to the temporal lobe and to understand the causes and consequences of TP atrophy.…”

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confidence: 99%

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Temporal lobe structural evaluation after transsylvian selective amygdalohippocampectomy

Giacomini

Souza

Formentin³

et al. 2020

Neurosurgical Focus

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OBJECTIVEMesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy in adolescents and adults, and in 65% of cases, it is related to hippocampal sclerosis (HS). Selective surgical approaches to the treatment of MTLE have as their main goal resection of the amygdala and hippocampus with minimal damage to the neocortex, temporal stem, and optic radiations (ORs). The object of this study was to evaluate late postoperative imaging findings on the temporal lobe from a structural point of view.METHODSThe authors conducted a retrospective evaluation of all patients with refractory MTLE who had undergone transsylvian selective amygdalohippocampectomy (SAH) in the period from 2002 to 2015. A surgical group was compared to a control group (i.e., adults with refractory MTLE with an indication for surgical treatment of epilepsy but who did not undergo the surgical procedure). The inferior frontooccipital fasciculus (IFOF), uncinate fasciculus (UF), and ORs were evaluated on diffusion tensor imaging analysis. The temporal pole neocortex was evaluated using T2 relaxometry.RESULTSFor the IFOF and UF, there was a decrease in anisotropy, voxels, and fibers in the surgical group compared with those in the control group (p < 0.001). An increase in relaxometry time in the surgical group compared to that in the control group (p < 0.001) was documented, suggesting gliosis and neuronal loss in the temporal pole.CONCLUSIONSSAH techniques do not seem to totally preserve the temporal stem or even spare the neocortex of the temporal pole. Therefore, although the transsylvian approaches have been considered to be anatomically selective, there is evidence that the temporal pole neocortex suffers structural damage and potentially functional damage with these approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

mentioning

confidence: 99%

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Temporal lobe structural evaluation after transsylvian selective amygdalohippocampectomy

Giacomini

Souza

Formentin³

et al. 2020

Neurosurgical Focus

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“…1). More details about the surgical procedure can be found in [3,4]. All volumes have manual annotations of the hippocampus, performed by one rater.…”

Section: Hcunicampmentioning

confidence: 99%

“…The hippocampus is a small, medial, subcortical brain structure related to long and short term memory [1]. The hippocampus can be affected in shape and volume by different pathologies, such as the neurodegeneration associated to Alzheimer's disease [2], or surgical intervention to treat temporal lobe epilepsy [3]. Hippocampal segmentation from magnetic resonance imaging (MRI) is of great importance for research of neuropsychiatric disorders and can also be used in the preoperatory investigation of pharmacoresistant temporal lobe epilepsy [4].…”

Section: Introductionmentioning

confidence: 99%

Hippocampus segmentation on epilepsy and Alzheimer's disease studies with multiple convolutional neural networks

Carmo

Silva

Initiative

et al. 2021

Heliyon

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Background: Hippocampus segmentation on magnetic resonance imaging is of key importance for the diagnosis, treatment decision and investigation of neuropsychiatric disorders. Automatic segmentation is an active research field, with many recent models using deep learning. Most current state-of-the art hippocampus segmentation methods train their methods on healthy or Alzheimer's disease patients from public datasets. This raises the question whether these methods are capable of recognizing the hippocampus on a different domain, that of epilepsy patients with hippocampus resection. New Method: In this paper we present a state-of-the-art, open source, ready-to-use, deep learning based hippocampus segmentation method. It uses an extended 2D multi-orientation approach, with automatic preprocessing and orientation alignment. The methodology was developed and validated using HarP, a public Alzheimer's disease hippocampus segmentation dataset. Results and Comparisons: We test this methodology alongside other recent deep learning methods, in two domains: The HarP test set and an in-house epilepsy dataset, containing hippocampus resections, named HCUnicamp. We show that our method, while trained only in HarP, surpasses others from the literature in both the HarP test set and HCUnicamp in Dice. Additionally, Results from training and testing in HCUnicamp volumes are also reported separately, alongside comparisons between training and testing in epilepsy and Alzheimer's data and vice versa. Conclusion: Although current state-of-the-art methods, including our own, achieve upwards of 0.9 Dice in HarP, all tested methods, including our own, produced false positives in HCUnicamp resection regions, showing that there is still room for improvement for hippocampus segmentation methods when resection is involved.

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Fractional anisotropy of the optic radiations correlates with the visual field after epilepsy surgery

et al. 2019

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Clinical and Imaging Evaluation of Transuncus Selective Amygdalohippocampectomy

Cited by 10 publications

References 19 publications

Temporal lobe structural evaluation after transsylvian selective amygdalohippocampectomy

Temporal lobe structural evaluation after transsylvian selective amygdalohippocampectomy

Hippocampus segmentation on epilepsy and Alzheimer's disease studies with multiple convolutional neural networks

Fractional anisotropy of the optic radiations correlates with the visual field after epilepsy surgery

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