Transinferior Temporal Amygdalohippocampectomy for Temporal Lobe Epilepsy

Abstract

Purpose: We describe a new surgical approach for removing the amygdalohippocampal complex. This approach does not require difficult surgical techniques, has had no complications so far, and the operative results have been excellent for obtaining sufficient seizure control. Methods: After a temporal craniotomy, the inferior temporal gyrus is exposed. A cortical incision, 15 nun superior and parallel to the temporal base, from the temporal tip to 50 mm (left side) or 60 mm (right side) posterior to it is made. The incision is deepened to reach to the arachnoid near the tentorial edge. When this is accomplished, the inferior temporal horn is opened widely, and the entire hippocampus is exposed. The hippocampus, as well as the parahippocampal gyrus, is removed in two pieces of ∼2 cm long each. The inferior half of the amygdala and the temporal basal cortex just in front of the head of hippocampus is also removed. Results: Of the 30 operated on cases that were followed up for > 1 year, 25 were completely seizure free, two had only a few auras a year, two had a few complex partial seizures a year, and one showed no change. This distribution is quite satisfactory. Conclusion: This approach is easy, but the results are satisfactory. Of course, the anterior temporal approach is the standard technique; however, the novel approach should be considered, especially when the entire hippocampus is to be removed.