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

Abstract

The deep knowledge of hippocampal microsurgical anatomy is paramount in epilepsy surgery. One of the most used techniques is those proposed by Niemeyer. To describe the hippocampal anatomy in detail and to present a technique in which preoperative anatomical points in MRI are identified to guide the corticotomy. Microsurgical dissections were performed in twenty brain hemispheres and eight cadaveric heads to identify temporal lobe and hippocampus structures. Thirty two patients with drug-resistant temporal lobe epilepsy underwent a selective amygdalohippocampectomy with Niemeyer's technique being measured three preoperative MRI preoperative distances to guide the corticotomy. The hippocampus was divided in head, body and tail and its microsurgical anatomy described in detail. The MRI measurements are presented and discussed. The knowledge of the complex anatomy of the hippocampus can be achieved in a three-dimensional way during microsurgical dissections. The preoperative MRI measurement is a reasonable guide to perform temporal corticotomy in Niemeyer's technique.