Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications.

Aarona Cohen-Gadol,Timothyj Kovanda,Rshane Tubbs

doi:10.4103/2152-7806.140651

Abstract

Background:A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA), which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex.Methods:In this article, the authors describe technical nuances to improve the safety of SA.Results:Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation.Conclusion:SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.

Highlights

The optimal procedure is a matter of debate, the goal of each operation is to remove the epileptogenic zone while preserving the surrounding normal anatomy, thereby limiting the morbidity associated with the procedure
Anterior temporal lobectomy (ATL) has been shown in a randomized, controlled trial to be superior to medical management for relief of Medial temporal lobe epilepsy (MTLE)[44] and selective amygdalohippocampectomy (SA) was developed to preserve the lateral temporal neocortex, especially on the dominant hemisphere.[46]
We describe the technical aspects of SA, focusing on preoperative evaluation and, more importantly, on surgical anatomy and technique to avoid complications

Summary

Background:

A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex

Results

Conclusion

INTRODUCTION

CONCLUSIONS

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