The selective amygdalohippocampectomy for intractable temporal limbic seizures

Area of Science:

• Neurosurgery
• Epilepsy Surgery
• Microsurgery

Background:

• The proximal (anterior) transsylvian approach was developed in 1967 for various brain lesions.
• It was later adapted in 1973 for selective amygdalohippocampectomy in intractable mesial temporal lobe epilepsy.

Purpose of the Study:

• To evaluate the efficacy and safety of the proximal transsylvian-transamygdala approach for selective amygdalohippocampectomy.
• To present surgical outcomes in patients with mesial temporal lobe epilepsy.

Main Methods:

• Selective two-thirds resection of amygdala and hippocampus-parahippocampus via transsylvian-transamygdala route.
• Preservation of overlying neopallial gyri and subcortical connective fiber systems.
• Avoidance of rigid retractors and computer-assisted navigation; tractography confirmed intact fiber systems postoperatively.

Main Results:

• No surgical mortality or morbidity in 188 patients (73 from 1994-2006 presented here).
• No new neurological deficits, neurocognitive dysfunction, or impairment of preoperative incapacities observed.
• Previous publications detail outcomes for neoplastic and vascular lesions, and 102 epilepsy patients.

Conclusions:

• Rewarding seizure outcomes achieved in the majority of patients.
• Success was particularly noted in patients with preoperative EEG, MRI, and PET findings indicative of localized temporal lobe dysfunction.
• The technique demonstrates safety and efficacy for epilepsy surgery.