Subtemporal Amygdalohippocampectomy for Treating Medically Intractable Temporal Lobe Epilepsy

Abstract

A SUBTEMPORAL AMYGDALOHIPPOCAMPECTOMY technique has been developed for mesial temporal lobe epilepsy. The conventional subtemporal approach has been modified to diminish temporal lobe retraction and the risk of damage to the temporal lobe. In the new technique, the surgeons' position has moved from above to below and the approach has been changed from anterolateral to posterolateral, thereby avoiding the voluminous and steeply inclined anterior temporal lobe. By this modified approach, it was unnecessary to remove the roof of the external auditory meatus and it was estimated that both the retraction pressure and the extent of temporal lobe retraction were reduced. To date, surgeons using this approach have operated on four patients with temporal lobe epilepsy whose epileptic foci were in the mesial temporal structure; the inferior temporal gyrus, the temporal tip, the vein of Labbé, and the ventral bridging veins were preserved. After surgery, two patients became completely free of seizures and the other two showed over 90% reduction in seizure frequency without neurological sequelae. Postoperative visual field examination revealed full visual fields without quadrantanopsia. This approach can preserve the temporal stem and lateral temporal lobe, it can be used to remove as much of the posterior hippocampus as necessary, and it can be extended to conventional lobectomy if it is indicated.

Transcortical Selective Amygdalohippocampectomy in Temporal Lobe Epilepsy

“…45 Over the years at the MNI, we have used various modalities of transcortical approaches, initially through the first temporal gyrus, later through the superior temporal sulcus and, for many years now, through the second temporal gyrus, an approach similar to that suggested by Niemeyer. 46,47 The originality of the technique to be described resides in the strictly endopial resection of the hippocampal formation and amygdala and the use of computer image guidance to perform the procedure.…”

Anatomia microcirúrgica do hipocampo na Amígdalo-hipocampectomia seletiva sob a perspectiva da técnica de Niemeyer e método pré-operatório para maximizar a corticotomia

“…No que diz respeito à amígdalo-hipocampectomia seletiva, duas vias classicamente descritas podem ser utilizadas: a transilviana e a transcortical. A via transcortical pode ser realizada não somente através do giro temporal médio, como proposto por Niemeyer, mas também através da parte anterior do giro temporal superior 12 , do sulco temporal superior 13 ou subtemporal 14 . O objetivo da amígdalo-hipocampectomia seletiva é ressecar a parte anterior do hipocampo (1,5 a 2,5 cm, ou mais), parte do parahipocampo, o giro dentato, o úncus e a parte temporal da amígdala.…”

Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy

“…Surgical options include the standard anterior temporal lobe resection (TLR) as well as a more selective resection of the mesial temporal lobe structures, first introduced by Niemeyer in 1958 as selective amygdalohippocampectomy (SAH). After the establishment of microsurgery by Yasargil, multiple microsurgical approaches for SAH have been described with the proximal transsylvian selective transamygdalohippocampectomy [2], the transsylvian-transcisternal mesial en bloc resection [3], the subtemporal approach [4], and the trans-middle temporal gyrus approach [5] being the most frequently used ones.…”