Related Experiment Video
Updated: Dec 29, 2025
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
[microsurgery 'burr hole' for intracranial tumors and mesial temporal lobe epilepsy]
D I Pitskhelauri1, E S Kudieva1, A E Bykanov1
1Burdenko Neurosurgical Center, Moscow, Russia.
Purpose:
In recent years, neurosurgery has been characterized by a clear tendency towards the development of minimally invasive and less traumatic surgical approaches. To minimize the degree of injury to the brain tissue, we have proposed burr hole-based microsurgical approaches.
Material And Methods:
In the period between February 2016 and February 2019, more than 500 microsurgical interventions were performed through a 14 mm burr hole using a technique that we called burr-hole microneurosurgery; to date, 200 of these have been analyzed. The age of patients varied from 16 to 79 years (median, 38 years). Female patients predominated - 1.6:1. Surgery for intracranial lesions with various locations was performed in 176 cases; in the remaining 24 cases, patients with hippocampal sclerosis underwent selective amygdalohippocampectomy.
Results:
Various surgical approaches were used: transcortical approach in 81 (40.5%) cases; retro-sigmoid approach in 38 (19%); sub-temporal approach in 32 (16%); infratentorial supracerebellar approach in 25 (12.5%); interhemispheric approach in 17 (8.5%); telovelar approach in 5 (2.5%); trans-eyebrow approach in 2 cases. The resection degree was evaluated in 167 patients with planned maximum tumor resection. Resection was total and almost total in 145 (87%) patients, subtotal in 15 (9%), and partial in 7 (4%). The surgery duration varied from 35 to 300 min (mean, 80 min). The extubation time after surgery ranged from 5 min to 5 days (mean, 70 min). In 195 (97.5%) cases, patients were verticalized within the first 3 days after surgery.
Conclusion:
The proposed burr hole technique enables successful surgery in patients with various intracranial pathologies, using a smaller trepanation window compared to that in keyhole surgery. The proposed burr hole technique minimizes injury to the brain substance, significantly reduces patient's exposure to anesthesia, and decreases the entire duration of surgery.
Insights
This study introduces burr-hole microneurosurgery, a minimally invasive technique for brain surgery. This approach offers reduced brain injury, shorter anesthesia, and faster recovery for various intracranial pathologies.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Microsurgery
Background:
- Neurosurgery trends towards less invasive approaches.
- Minimizing brain tissue injury is a key objective.
- Burr hole-based microsurgical techniques are proposed.
Purpose of the Study:
- To evaluate the efficacy of burr-hole microneurosurgery.
- To minimize brain tissue damage during intracranial procedures.
- To assess the outcomes of a novel burr hole technique.
Main Methods:
- Analysis of 200 microsurgical interventions performed via a 14 mm burr hole.
- Patient age range: 16-79 years (median 38).
- Procedures included intracranial lesions and selective amygdalohippocampectomy for hippocampal sclerosis.
Main Results:
- Multiple surgical approaches utilized through the burr hole.
- High rates of total/almost total tumor resection (87%).
- Mean surgery duration: 80 minutes; mean extubation: 70 minutes; 97.5% verticalized within 3 days.
Conclusions:
- Burr hole microneurosurgery is effective for diverse intracranial pathologies.
- This technique uses a smaller trepanation window than keyhole surgery.
- Benefits include minimized brain injury, reduced anesthesia exposure, and shorter surgery duration.
