Selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy: operative and neuropsychological outcomes

Hori, Tomokatsu; Yamane, Fumitaka; Ochiai, Taku; Kondo, Shinji; Shimizu, Satoru; Miyata, Hajime

doi:10.3171/jns.2007.106.1.134

Cited by 83 publications

(49 citation statements)

References 30 publications

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“…In contrast, Hori et al 7 reported no loss of verbal memory in their patients; there were no significant differences in verbal memory between patients who underwent surgery on the dominant hemisphere and those who underwent surgery on the nondominant hemisphere, and there was no significant loss of memory postoperatively compared with preoperatively. In addition, some other studies in which subtemporal SAH was performed also reported no loss of verbal memory.…”

Section: Discussionmentioning

confidence: 74%

“…4 By drilling away the retrolabyrinthine presigmoid petrosal bone, at least 1 cm more space below and 1 cm more space medially was obtained than in the conventional subtemporal approach, and temporal retraction pressure was diminished. In a subsequent report of 26 cases, 7 there were encouraging neuropsychological and seizure outcomes. There were no injuries to any bridging veins, including the vein of Labbé.…”

Section: Discussionmentioning

confidence: 99%

“…4 By drilling away the retrolabyrinthine presigmoid petrosal bone, at least 1 cm of additional space below and 1 cm of additional space medially is obtained, in comparison to the space provided by the usual subtemporal approach, and temporal retraction pressure is diminished when approaching from below. 4 In a subsequent report of 26 cases, Hori et al 7 presented encouraging neuropsychological and seizure outcomes, and no injuries to the vein of Labbé were reported. In 2009, Yang et al 21 reported similar outcomes using the so-called Hori approach with a large bone flap and a reversed U-shaped skin incision surrounding the auricle.…”

mentioning

confidence: 99%

“…However, subtemporal approaches afford little working space, risk injury to the vein of Labbé, and require vigorous brain retraction. 4,5,7,21 To avoid such damage to the temporal lobe, Hori et al modified the conventional subtemporal approach. 4 By drilling away the retrolabyrinthine presigmoid petrosal bone, at least 1 cm of additional space below and 1 cm of additional space medially is obtained, in comparison to the space provided by the usual subtemporal approach, and temporal retraction pressure is diminished when approaching from below.…”

mentioning

confidence: 99%

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Neuropsychological outcomes of subtemporal selective amygdalohippocampectomy via a small craniotomy

Yang¹,

Zhang²,

Pei³

et al. 2016

JNS

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T emporal lobectomy has been established as a definitive treatment for medically intractable temporal lobe epilepsy.19 When the seizures originate from the mesial part of the temporal lobe only, the lateral temporal neocortex should be preserved at all costs to minimize postoperative neuropsychological dysfunction. 5,10,20 The type of operation that spares the lateral temporal neocortex is defined as selective amygdalohippocampectomy (SAH). Surgical approaches to the mesial temporal lobe can be broadly grouped into 3 categories: transsylvian, 20,22 transtemporal, 1,10,11,17,18 and subtemporal. 4-9,12,13,21 Each approach has its advantages and potential pitfalls. Compared with the transsylvian and transtemporal approaches, the subtemporal approach is the most straightforward method to expose the mesiobasal part of the temporal lobe, including the fusiform gyrus and parahippocampal gyrus. This corridor preserves functional temporal lobe tissue in the superior, middle, and inferior temporal gyri. It avoids disruption of the frontotemporal white matter pathways in the temporal stem and the visual fibers near the roof of the abbreviatioNs EEG = electroencephalography; MTLE = mesial temporal lobe epilepsy; MTS = mesial temporal sclerosis; PSSAH = posterior subtemporal SAH; SAH = selective amygdalohippocampectomy. obJective The objectives of this study were to describe a novel minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with medically refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis, and to analyze the related outcomes. methods The authors analyzed data from all cases involving patients with unilateral MTLE due to hippocampal sclerosis who were treated with selective amygdalohippocampectomy via the posterior subtemporal approach through a relatively small craniotomy, without a neuronavigation system, at their institution during the period from September 2010 to September 2012. Data were obtained on baseline characteristics, preoperative evaluations of unilateral mesial temporal sclerosis, surgical complications, and Engel class seizure outcomes. All patients underwent memory testing, IQ testing, and language testing. results The mean duration of follow-up was 33.6 months (range 24-48 months). There were no deaths and no cases of significant postoperative morbidity. One patient had a mild complication. At 2-year follow-up, 19 patients were seizure free (Engel Class I outcome). Verbal memory scores obtained at 3 months and at 2 years after surgery were significantly lower than preoperative scores for patients who underwent surgery on the left side of the brain (p < 0.05). Pictorial memory scores were higher following surgery compared with before surgery regardless of whether patients underwent left- or right-sided brain surgery. There was also improvement in performance IQ and total IQ following surgery in both groups. For patients who underwent right-sided brain surgery, verbal comprehension and semantic fluency testing scores wer...

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Neuropsychological outcomes of subtemporal selective amygdalohippocampectomy via a small craniotomy

Yang¹,

Zhang²,

Pei³

et al. 2016

JNS

View full text Add to dashboard Cite

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“…This approach, directed through the occipitotemporal gyrus or the collateral sulcus on the inferior surface of the temporal lobe, has been used to access the posterior part of the hippocampus and the inferior part of the atrium for amygdalohippocampectomy without any visual or memory deficits. 39,48,84 Based on our dissections, the Li-Am fasciculus may be damaged in this approach ( Fig. 16; Table 3).…”

Section: 573112mentioning

confidence: 99%

The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus

Güngör¹,

Baydın²,

Middlebrooks

et al. 2017

JNS

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S urgical approaches to the lateral ventricle always require passage through one and often multiple fiber tracts to reach their target. These approaches remain a challenge because of the deep location and variable shape and size of the ventricles, their covering mantle of tracts, and relationships to important neural structures such as the thalamus and internal capsule. 55,75,84 In addition, a number of tracts course in the walls of the ventricle where they are separated from the cerebrospinal fluid by only a thin layer of ependyma and would likely be exposed to the greatest possibility of damage by hydrocephalus.84,124 Recent studies have focused on the relationships of the fiber tracts to eloquent cortical areas and avoiding the optic radiations in approaches to the lateral ventricle. 16,41,48,59,63,75,89,92,94,125 The aim of the present study was to explore the relationships of the tracts to the lateral ventricles and the various surgical approaches to the ventricles and to examine the anatomy and syndromes related to ventricular enlargement. MethodsForty adult human formalin-fixed cadaveric hemispheres (20 brains) were examined under magnification that ranged from ×6 to ×40. The dura, pia, arachnoid, and surface vessels were gently removed. All specimens were frozen in water for at least 2 weeks at -16°C, as described by Klingler, to separate the tracts and facilitate dissection. 51 After freezing, the specimens were thawed and rinsed of formalin under tap water for at least 1 hour. Prior OBJECTIVEThe relationship of the white matter tracts to the lateral ventricles is important when planning surgical approaches to the ventricles and in understanding the symptoms of hydrocephalus. The authors' aim was to explore the relationship of the white matter tracts of the cerebrum to the lateral ventricles using fiber dissection technique and MR tractography and to discuss these findings in relation to approaches to ventricular lesions. METHODS Forty adult human formalin-fixed cadaveric hemispheres (20 brains) and 3 whole heads were examined using fiber dissection technique. The dissections were performed from lateral to medial, medial to lateral, superior to inferior, and inferior to superior. MR tractography showing the lateral ventricles aided in the understanding of the 3D relationships of the white matter tracts with the lateral ventricles. RESULTS The relationship between the lateral ventricles and the superior longitudinal I, II, and III, arcuate, vertical occipital, middle longitudinal, inferior longitudinal, inferior frontooccipital, uncinate, sledge runner, and lingular amygdaloidal fasciculi; and the anterior commissure fibers, optic radiations, internal capsule, corona radiata, thalamic radiations, cingulum, corpus callosum, fornix, caudate nucleus, thalamus, stria terminalis, and stria medullaris thalami were defined anatomically and radiologically. These fibers and structures have a consistent relationship to the lateral ventricles. CONCLUSIONS Knowledge of the relationship of the white matter tracts o...

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Epilepsy: Viewpoint—Surgery

Carter

Tovar-Spinoza

2015

Principles and Practice of Stereotactic Radiosurgery

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Selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy: operative and neuropsychological outcomes

Abstract: Subtemporal selective amygdalohippocampectomy provides favorable surgical and neuropsychological outcomes and does not cause significant postoperative decline of verbal memory if performed on the language-dominant side.

Cited by 83 publications

References 30 publications

Neuropsychological outcomes of subtemporal selective amygdalohippocampectomy via a small craniotomy

Neuropsychological outcomes of subtemporal selective amygdalohippocampectomy via a small craniotomy

The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus

Epilepsy: Viewpoint—Surgery

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