Selective amygdalohippocampectomy: the trans-middle temporal gyrus approach

2008 ◽  
Vol 25 (3) ◽  
pp. E4 ◽  
Author(s):  
B. Matt Wheatley
Keyword(s):  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Anterior Temporal Lobectomy ◽  
Middle Temporal ◽  
Selective Amygdalohippocampectomy ◽  
Temporal Structures ◽  
Mesial Temporal Lobe ◽  
Temporal Neocortex

The most common surgical procedure for the mesial temporal lobe is the standard anterior temporal resection or what is commonly called the anterior temporal lobectomy. There are, however, a number of other more selective procedures for removal of the mesial temporal lobe structures (amygdala, hippocampus, and parahippocampal gyrus) that spare much of the lateral temporal neocortex. Included in these procedures collectively referred to as selective amygdalohippocampectomy are the transsylvian, subtemporal, and transcortical (trans-middle temporal gyrus) selective amygdalohippocampectomy. In this manuscript the author reviews some of the surgical details of the trans-middle temporal gyrus approach to the mesial temporal structures.

scholarly journals Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

2015 ◽  
Vol 74 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Fábio A. Nascimento ◽  
Luana Antunes Maranha Gatto ◽  
Carlos Silvado ◽  
Maria Joana Mäder-Joaquim ◽  
Marlus Sidney Moro ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference ◽  
Mesial Temporal Lobe ◽  
Neuropsychological Outcomes

ABSTRACT Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

scholarly journals Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Alireza Mansouri ◽  
Aria Fallah ◽  
Mary Pat McAndrews ◽  
Melanie Cohn ◽  
Diana Mayor ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference ◽  
Mesial Temporal Lobe ◽  
Neuropsychological Outcomes

Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student’s t-test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted.

scholarly journals Stereotactic EEG-guided radiofrequency thermocoagulation versus anterior temporal lobectomy for mesial temporal lobe epilepsy with hippocampal sclerosis: study protocol for a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yi-He Wang ◽  
Si-Chang Chen ◽  
Peng-Hu Wei ◽  
Kun Yang ◽  
Xiao-Tong Fan ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Controlled Trial ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Radiofrequency Thermocoagulation ◽  
Mesial Temporal Lobe ◽  
Randomised Controlled

Abstract Introduction In this report, we aim to describe the design for the randomised controlled trial of Stereotactic electroencephalogram (EEG)-guided Radiofrequency Thermocoagulation versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (STARTS). Mesial temporal lobe epilepsy (mTLE) is a classical subtype of temporal lobe epilepsy that often requires surgical intervention. Although anterior temporal lobectomy (ATL) remains the most popular treatment for mTLE, accumulating evidence has indicated that ATL can cause tetartanopia and memory impairments. Stereotactic EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a non-invasive alternative associated with lower seizure freedom but greater preservation of neurological function. In the present study, we aim to compare the safety and efficacy of SEEG-guided RF-TC and classical ATL in the treatment of mTLE. Methods and analysis STARTS is a single-centre, two-arm, randomised controlled, parallel-group clinical trial. The study includes patients with typical mTLE over the age of 14 who have drug-resistant seizures for at least 2 years and have been determined via detailed evaluation to be surgical candidates prior to randomisation. The primary outcome measure is the cognitive function at the 1-year follow-up after treatment. Seizure outcomes, visual field abnormalities after surgery, quality of life, ancillary outcomes, and adverse events will also be evaluated at 1-year follow-up as secondary outcomes. Discussion SEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual field protection. This is the first RCT studying cognitive outcomes and treatment results between SEEG-guided RF-TC and standard ATL for mTLE with hippocampal sclerosis. This study may provide higher levels of clinical evidence for the treatment of mTLE. Trial registration ClinicalTrials.gov NCT03941613. Registered on May 8, 2019. The STARTS protocol has been registered on the US National Institutes of Health. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

Experience From 211 Transcortical Selective Amygdalohippocampectomy Procedures: Relevant Surgical Anatomy and Review of the Literature

2021 ◽  
Author(s):  
Rushna Ali ◽  
Dario J Englot ◽  
Hong Yu ◽  
Robert Naftel ◽  
Kevin F Haas ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Outcome Data ◽  
Surgical Anatomy ◽  
Temporal Lobectomy ◽  
Middle Temporal Gyrus ◽  
Seizure Freedom ◽  
Review Of Literature ◽  
Selective Amygdalohippocampectomy ◽  
Complex Anatomy ◽  
Institutional Experience

Abstract BACKGROUND Selective amygdalohippocampectomy (SelAH) is designed to treat medically refractory mesial temporal lobe epilepsy with reduced morbidity compared to standard anterior temporal lobectomy. At our institution, we perform SelAH via a transcortical approach via small corticectomy in the middle temporal gyrus. OBJECTIVE To discuss the surgical anatomy and nuances of SelAH, share our institutional experience, and perform a review of literature. METHODS Institutional experience was recorded by collecting demographic and outcome data from 1999 to 2017 under an Institutional Review Board protocol in a prospective manner using a REDCap database. RESULTS A total of 211 SelAH procedures were performed at our institution between 1999 and 2017. Of these patients, 54% (113/211) were females. The average age at surgery was 39.4 yr. Two-year Engel outcome data were available for 168 patients, of which 73% (123/168) had Engel I outcomes. Engel II outcomes were reported in 16.6% (28/168), III in 4.7% (8/168), and IV in 5.3% (9/168). Our review of literature showed that this is comparable to the seizure freedom rates reported by other groups. We then reviewed our surgical methodology based on operative reports and created illustrations of the surgical anatomy of temporal lobe approach. These illustrations were compared with postoperative magnetic resonance imaging to provide a better 3D understanding of the complex architecture of mesial temporal structures. CONCLUSION SelAH is a minimally invasive, safe, and effective approach for the treatment of medically refractory epilepsy with good surgical outcomes and low morbidity. We feel that mastering the complex anatomy of this approach helps achieve successful outcomes.

Subtemporal transparahippocampal amygdalohippocampectomy for surgical treatment of mesial temporal lobe epilepsy

1996 ◽  
Vol 1 (4) ◽  
pp. E2 ◽  
Author(s):  
T. S. Park ◽  
Blaise F. D. Bourgeois ◽  
Daniel L. Silbergeld ◽  
W. Edwin Dodson
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Pediatric Patients ◽  
Mesial Temporal Lobe Epilepsy ◽  
Fusiform Gyrus ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Language Mapping ◽  
Mesial Temporal Lobe ◽  
Sodium Amobarbital

Amygdalohippocampectomy (AH) is an accepted surgical option for treatment of medically refractory mesial temporal lobe epilepsy. Operative approaches to the amygdala and hippocampus that previously have been reported include: the sylvian fissure, the superior temporal sulcus, the middle temporal gyrus, and the fusiform gyrus. Regardless of the approach, AH permits not only extirpation of an epileptogenic focus in the amygdala and anterior hippocampus, but interruption of pathways of seizure spread via the entorhinal cortex and the parahippocampal gyrus. The authors report a modification of a surgical technique for AH via the parahippocampal gyrus, in which excision is limited to the anterior hippocampus, amygdala and parahippocampal gyrus while preserving the fusiform gyrus and the rest of the temporal lobe. Because transparahippocampal AH avoids injury to the fusiform gyrus and the lateral temporal lobe, it can be performed without intracarotid sodium amobarbital testing of language dominance and language mapping. Thus the operation would be particularly suitable for pediatric patients in whom intraoperative language mapping before resection is difficult.

Pathological Status of the Mesial Temporal Lobe Predicts Memory Outcome from Left Anterior Temporal Lobectomy

Neurosurgery ◽  
1992 ◽  
Vol 31 (4) ◽  
pp. 652-657 ◽  
Author(s):  
Bruce P. Hermann ◽  
Allen R. Wyler ◽  
Grant Somes ◽  
Allen D. Berry ◽  
F. Curtis Dohan
Keyword(s):  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Mesial Temporal Lobe

Prospective analysis of diplopia after anterior temporal lobectomy for mesial temporal lobe sclerosis

2003 ◽  
Vol 99 (3) ◽  
pp. 496-499 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Jacqueline A. Leavitt ◽  
James J. Lynch ◽  
W. Richard Marsh ◽  
Gregory D. Cascino
Keyword(s):  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Palpebral Fissure ◽  
Ophthalmological Examination ◽  
Trochlear Nerve ◽  
Anterior Temporal Lobectomy ◽  
Content Type ◽  
Nerve Dysfunction ◽  
Mesial Temporal Lobe ◽  
Fine Print

Object. In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing anterior temporal lobectomy (ATL) and amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy. Methods. Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. Conclusions. Postoperative diplopia following ATL occurs more often than previously thought and is primarily due to trochlear nerve dysfunction. Awareness of this transient complication is important in preoperative patient counseling.

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