Transorbital endoscopic amygdalohippocampectomy: a feasibility investigation

Object Resection of the hippocampus is the standard of care for medically intractable epilepsy in patients with mesial temporal sclerosis. Although temporal craniotomy in this setting is highly successful, the procedure carries certain immutable risks and may be associated with cognitive deficits related to cortical and white matter disruption. Alternative surgical approaches may reduce some of these risks by preserving the lateral temporal lobe. This study examined the feasibility of transorbital endoscopic amygdalohippocampectomy (TEA) as an alternative to open craniotomy in cadaveric specimens. Methods TEA dissections were performed in 4 hemispheres from 2 injected cadaveric specimens fixed in alcohol. Quantitative predictions of the limits of exposure based on predissection imaging were compared with intradissection measurements. The extent of resection and angles of exposure during the dissection and on postdissection imaging were recorded. These measurements were validated with MRI studies from 10 epilepsy patients undergoing standard surgical evaluations. Results The transorbital approach permitted direct access to the mesial temporal structures through the lateral orbital wall. Up to 97% of the hippocampal formation was resected with no brain retraction and minimal (mean 6.0 ± 1.4 mm) globe displacement. Lateral temporal lobe white matter tracts were preserved. Conclusions TEA permits hippocampectomy comparable to standard surgical approaches without disrupting the lateral temporal cortex or white matter. This novel approach is feasible in cadaveric specimens and warrants clinical investigation in carefully selected cases.

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Voxel-based Optimized Morphometry (VBM) of Gray and White Matter in Temporal Lobe Epilepsy (TLE) with and without Mesial Temporal Sclerosis

Epilepsia ◽

10.1111/j.1528-1167.2006.00512.x ◽

2006 ◽

Vol 47 (5) ◽

pp. 900-907 ◽

Cited By ~ 116

Author(s):

Suzanne G. Mueller ◽

Kenneth D. Laxer ◽

Nathan Cashdollar ◽

Shannon Buckley ◽

Crystal Paul ◽

...

Keyword(s):

White Matter ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Sclerosis

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Intractable Temporal Lobe Epilepsy (TLE) From Tuberculoma; Microneurosurgical Management of by Amygdalohippocampectomy with Lesionectomy Plus Standard Anterior Temporal lobectomy: A Case Report and Short Review of Literature

Journal of Surgical Sciences ◽

10.3329/jss.v16i2.43658 ◽

2019 ◽

Vol 16 (2) ◽

pp. 106-109

Author(s):

Forhad Hossain Chowdhury ◽

Mohammod Raziul Haque ◽

AFM Momtazul Haque

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Medial Temporal Lobe ◽

Venous Malformation ◽

Intractable Epilepsy ◽

Complex Partial Seizure ◽

Temporal Lobectomy ◽

Mesial Temporal Sclerosis ◽

Low Grade ◽

Presenting Symptoms

Patient presenting as a case of Temporal Lobe Epilepsy (TLE) are usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Here we report a case of surgically treated TLE that was due to a large tuberculoma in medial temporal lobe. Intractable epilepsy caused by tuberculoma is rare. The only presenting symptoms was Complex partial seizure (Psychomotor epilepsy) for which the patient underwent scalp EEG (Electro Encephalography) and MRI (Magnetic resonance imaging) of brain. The patient was managed by amygdalohippocampectomy with lesionectomy plus standard anterior lobectomy. Postoperatively she was on anti-tubercular therapy and on carbamazepine. The case was seizure and disease free till last follow up. Journal of Surgical Sciences (2012) Vol. 16 (2) : 106-109

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Anatomy of the Anterior Temporal Lobe and the Frontotemporal Region Demonstrated by Fiber Dissection

Neurosurgery ◽

10.1227/01.neu.0000140843.62311.24 ◽

2004 ◽

Vol 55 (5) ◽

pp. 1174-1184 ◽

Cited By ~ 74

Author(s):

Diedrik Peuskens ◽

Johannes van Loon ◽

Frank Van Calenbergh ◽

Raymond van den Bergh ◽

Jan Goffin ◽

...

Keyword(s):

White Matter ◽

Temporal Lobe ◽

Anterior Commissure ◽

Three Dimensional ◽

Dimensional Structure ◽

Surgical Approaches ◽

Anterior Temporal Lobe ◽

White Matter Tracts ◽

Fiber Dissection ◽

Dissection Technique

Abstract OBJECTIVE: The white matter structure of the anterior temporal lobe and the frontotemporal region is complex and not well appreciated from the available neurosurgical literature. The fiber dissection method is an excellent means of attaining a thorough knowledge of the three-dimensional structure of the white matter tracts. This study was performed to demonstrate the usefulness of the dissection technique in understanding the white matter anatomy and the effects of current surgical approaches on the subcortical structure of the region. METHODS: Seventeen brain specimens obtained at routine autopsy were dissected by use of Klingler's fiber dissection technique after preparation by fixation and freezing. The dissections were performed with an operating microscope and followed a stepwise pattern of progressive white matter dissection. RESULTS: The dissection is described in an orderly fashion showing the white matter tracts of the anterior temporal lobe and the frontotemporal region. An insight is gained into the three-dimensional course of the anterior loop of the optic radiation, the temporal stem, the anterior commissure, and the ansa peduncularis. CONCLUSION: The anterior temporal lobe and the frontotemporal region contain several important white matter tracts that can be uniquely understood by performing a white matter dissection of the region. Surgical procedures on the anterior temporal lobe differ substantially as to their repercussions on the subcortical white matter tract anatomy, as shown by the findings in this study.

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Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country

Epilepsy Research and Treatment ◽

10.1155/2014/286801 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8

Author(s):

Abdulaziz Alsemari ◽

Faisal Al-Otaibi ◽

Salah Baz ◽

Ibrahim Althubaiti ◽

Hisham Aldhalaan ◽

...

Keyword(s):

Temporal Lobe ◽

Epilepsy Surgery ◽

Intractable Epilepsy ◽

Research Centre ◽

Mesial Temporal Sclerosis ◽

Brain Scans ◽

Temporal Epilepsy ◽

Dual Pathology ◽

Surgery Outcome ◽

Postoperative Seizure

Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC). Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3) at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS) and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp.,) and 3 years (76% and 75%, resp.,). The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%). Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI) brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53%) and (47%) seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47%) and (33%) seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

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Grey and white matter abnormalities in temporal lobe epilepsy with and without mesial temporal sclerosis

Journal of Neurology ◽

10.1007/s00415-013-6974-3 ◽

2013 ◽

Vol 260 (9) ◽

pp. 2320-2329 ◽

Cited By ~ 55

Author(s):

Cathy Scanlon ◽

Susanne G. Mueller ◽

Ian Cheong ◽

Miriam Hartig ◽

Michael W. Weiner ◽

...

Keyword(s):

White Matter ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Sclerosis ◽

White Matter Abnormalities

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Temporal Lobe Epilepsy Semiology

Epilepsy Research and Treatment ◽

10.1155/2012/751510 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 19

Author(s):

Robert D. G. Blair

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Epilepsy ◽

Intractable Epilepsy ◽

Febrile Seizures ◽

Mesial Temporal Sclerosis ◽

Careful Study ◽

Seizure Onset ◽

Seizure Semiology ◽

Seizure Onset Zone

Epilepsy represents a multifaceted group of disorders divided into two broad categories, partial and generalized, based on the seizure onset zone. The identification of the neuroanatomic site of seizure onset depends on delineation of seizure semiology by a careful history together with video-EEG, and a variety of neuroimaging technologies such as MRI, fMRI, FDG-PET, MEG, or invasive intracranial EEG recording. Temporal lobe epilepsy (TLE) is the commonest form of focal epilepsy and represents almost 2/3 of cases of intractable epilepsy managed surgically. A history of febrile seizures (especially complex febrile seizures) is common in TLE and is frequently associated with mesial temporal sclerosis (the commonest form of TLE). Seizure auras occur in many TLE patients and often exhibit features that are relatively specific for TLE but few are of lateralizing value. Automatisms, however, often have lateralizing significance. Careful study of seizure semiology remains invaluable in addressing the search for the seizure onset zone.

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Microsurgical Anatomy of the Temporal Lobe and Its Implications on Temporal Lobe Epilepsy Surgery

Epilepsy Research and Treatment ◽

10.1155/2012/769825 ◽

2012 ◽

Vol 2012 ◽

pp. 1-17 ◽

Cited By ~ 10

Author(s):

Baris Kucukyuruk ◽

R. Mark Richardson ◽

Hung Tzu Wen ◽

Juan Carlos Fernandez-Miranda ◽

Albert L. Rhoton

Keyword(s):

White Matter ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Close Relation ◽

Senior Author ◽

Surgical Approaches ◽

Microsurgical Anatomy ◽

Medial Surface ◽

Vascular Structures

Objective. We review the neuroanatomical aspects of the temporal lobe related to the temporal lobe epilepsy. The neuronal, the ventricular, and the vascular structures are demonstrated. Methods. The previous articles published from the laboratory of the senior author are reviewed. Results. The temporal lobe has four surfaces. The medial surface has a complicated microanatomy showing close relation to the intraventricular structures, such as the amygdala or the hippocampus. There are many white matter bundles in the temporal lobe showing relation to the extra- and intraventricular structures. The surgical approaches commonly performed to treat temporal lobe epilepsy are discussed under the light of these data. Conclusion. A thorough knowledge of the microanatomy is necessary in cortical, subcortical, and intraventricular structures of the temporal lobe to achieve better results.

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Association of magnetic resonance imaging identification of mesial temporal sclerosis with pathological diagnosis and surgical outcomes in children following epilepsy surgery

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.1.peds11447 ◽

2012 ◽

Vol 9 (5) ◽

pp. 552-561 ◽

Cited By ~ 11

Author(s):

Aimen Kasasbeh ◽

Edward C. Hwang ◽

Karen Steger-May ◽

S. Kathleen Bandt ◽

Amy Oberhelman ◽

...

Keyword(s):

White Matter ◽

Temporal Lobe ◽

Interrater Agreement ◽

Seizure Outcome ◽

Mesial Temporal Sclerosis ◽

Resonance Imaging ◽

Mri Findings ◽

Perfect Agreement ◽

Mri Studies ◽

Temporal Horn

Object Mesial temporal sclerosis (MTS) is widely recognized as a significant underlying cause of temporal lobe epilepsy. Magnetic resonance imaging is routinely used in the preoperative evaluation of children with epilepsy. The purpose of this study was to evaluate the prevalence, reliability, and prognostic value of MRI identification of MTS and MRI findings indicative of MTS in a series of patients who underwent resection of the medial temporal lobe for medically refractory epilepsy. Methods The authors reviewed the medical records and preoperative MRI reports of 25 patients who had undergone medial temporal resections (anterior temporal lobectomy or functional hemispherotomy) for medically intractable epilepsy. The preoperative MRI studies were presented for blinded review by 2 neuroradiologists who independently evaluated the radiographs for selected MTS features and provided a final interpretation. To quantify interrater agreement and accuracy, the findings of the 2 blinded neuroradiologists, the nonblinded clinical preoperative radiology report, and the final pathology interpretation were compared. Results The preoperative MRI studies revealed MTS in 6 patients (24%), and histopathological analysis verified MTS in 8 (32%) of 25 specimens. Six MRI features of MTS were specifically evaluated: 1) increased hippocampal signal intensity, 2) reduced hippocampal size, 3) atrophy of the ipsilateral hippocampal collateral white matter, 4) enlarged ipsilateral temporal horn, 5) reduced gray-white matter demarcation in the temporal lobe, and 6) decreased temporal lobe size. The most prevalent feature of MTS identified on MRI was a reduced hippocampal size, found in 11 of the MRI studies (44%). Analysis revealed moderate interrater agreement for MRI identification of MTS between the 2 blinded neuroradiologists and the nonblinded preoperative report (Cohen κ 0.40–0.59). Interrater agreement was highly variable for different MTS features indicative of MTS, ranging from poor to near perfect. Agreement was highest for increased hippocampal signal and decreased temporal lobe size and was consistently poor for reduced gray-white matter demarcation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and proportion perfect agreement were highest for increased hippocampal signal and reduced hippocampal size. An MRI finding of MTS was not predictive of seizure outcome in this small series. Conclusions Mesial temporal sclerosis identification on brain MRI in children evaluated for medial temporal resections has a PPV of 55%–67% and an NPV of 79%–87%. Increased hippocampal signal and reduced hippocampal size were associated with high predictive values, while gray-white differentiation and an enlarged temporal horn were not predictive of MTS. Seizure outcome following medial temporal resections was not associated with MRI findings of MTS or MRI abnormalities indicative of MTS in this small sample size.

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TEMPORAL LOBE SURGERY FOR INTRACTABLE EPILEPSY IN CHILDREN

Neurosurgery ◽

10.1227/01.neu.0000245615.32226.83 ◽

2006 ◽

Vol 59 (6) ◽

pp. 1203-1214 ◽

Cited By ~ 77

Author(s):

Mony Benifla ◽

Hiroshi Otsubo ◽

Ayako Ochi ◽

Shelly K. Weiss ◽

Elizabeth J. Donner ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Intractable Epilepsy ◽

Temporal Lobectomy ◽

Seizure Outcome ◽

Mesial Temporal Sclerosis ◽

Low Grade ◽

Cavernous Malformations ◽

The Mean ◽

Secondary Generalization

Abstract OBJECTIVE Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe epilepsy. In this study, we conducted a retrospective review of children with drug-resistant temporal lobe epilepsy to evaluate seizure outcome after temporal lobe surgery. METHODS We reviewed the medical records of 126 children who had surgery for temporal lobe epilepsy at The Hospital for Sick Children between 1983 and 2003. The records were examined for preoperative and intraoperative factors that could predict patient outcome after surgery. RESULTS The mean age at seizure onset was 5.9 years. The mean seizure duration before surgery was 5.6 years. All patients had preoperative computed tomographic scans, magnetic resonance imaging scans, or both. The mean age at the time of surgery was 13.5 years. Sixty-two patients underwent left temporal resections and 64 patients underwent right temporal resections. The histopathology of the temporal resections revealed low-grade brain tumors in 65 children (52%) and cavernous malformations in four children. Ganglioglioma and astrocytoma were the most common tumors encountered. Mesial temporal sclerosis was found in 16 patients (13%), astrogliosis in 15 patients (12%), and cortical dysplasia in eight patients (7%). Postoperative follow-up of at least 2 years was available for 106 patients and ranged up to 13.0 years. Seventy-four percent of patients had an Engel Class I or II outcome. Patients with temporal lobe lesions had better outcomes compared with those without lesions (P< 0.05). Patients without a history of secondary generalization of seizures also had a better outcome when compared with those with secondary generalization. Complications in the form of contralateral homonymous hemianopsia, dysphasia, and infection were found in 5% of patients. Twelve patients had a second temporal lobe procedure for intractable recurrent seizures. After a second procedure, seven patients returned to a seizure-free state. CONCLUSION Temporal lobe resections for epilepsy in children are effective and safe procedures, with a favorable impact on seizure control. Repeat temporal resections for recurrent seizures may also be effective in restoring a seizure-free outcome to children.

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