Abstract
Epilepsy surgery can be an effective epilepsy treatment for patients whose seizures do not respond to best medical therapy. For patients with temporal lobe epilepsy, selective amygdalohippocampectomy (SAH) has emerged as a viable alternative to standard anterior temporal lobectomy. This paper reviews the indications for SAH, the technical advances that have led to greater adoption of the procedure, the expectations for seizure control, and the risks of morbidity.
Highlights
Epilepsy is a common condition that affects nearly 1% of the world’s population
Selective amygdalohippocampectomy is employed in cases of medically refractory temporal lobe epilepsy of mesial temporal origin
Selective amygdalohippocampectomy has emerged as a viable alternative to standard anterior temporal lobectomy in patients with refractory temporal lobe epilepsy (TLE) of mesial temporal origin
Summary
Epilepsy is a common condition that affects nearly 1% of the world’s population. The World Health Organization reports that neurological disease outranks HIV, cancer, and coronary artery disease in years of life lost to disability, and among neurological conditions, epilepsy ranks 4th [1]. The benefit of epilepsy surgery in treatment-resistant epilepsy has been demonstrated in numerous case series as well as by a recent randomized clinical trial which demonstrated that surgery is clearly superior to best medical therapy in patients with temporal lobe epilepsy (TLE) [2]. The traditional surgical approach has been en bloc anterior temporal lobectomy (ATL). In this procedure, approximately 3–6 cm of anterior temporal neocortex is resected (depending on hemispheric language dominance), permitting access to resection of mesial structures. ATL offers advantages of good surgical exposure to allow complete resection of mesial structures, relatively low morbidity, and permits pathological examination of en bloc specimens. This procedure is still commonly employed today. More targeted mesial temporal resections that spared temporal neocortex (selective amygdalohippocampectomy) were envisioned as possible means of providing equivalent seizure control with fewer neuropsychological sequelae (Figure 1)
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