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Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study
Ruth Lau1,2, Andreu Gabarros3, Juan Martino4
1Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA. ruth_lau_rodriguez@hotmail.com.
Purpose:
Selective amygdalohippocampectomy (SelAH) is one of the most common surgical treatments for mesial temporal sclerosis. Microsurgical approaches are associated with the risk of cognitive and visual deficits due to damage to the cortex and white matter (WM) pathways. Our objective is to test the feasibility of an endoscopic approach through the anterior middle temporal gyrus (aMTG) to perform a SelAH.
Methods:
Virtual simulation with MRI scans of ten patients (20 hemispheres) was used to identify the endoscopic trajectory through the aMTG. A cadaveric study was performed on 22 specimens using a temporal craniotomy. The anterior part of the temporal horn was accessed using a tubular retractor through the aMTG after performing a 1.5 cm corticectomy at 1.5 cm posterior to the temporal pole. Then, an endoscope was introduced. SeIAH was performed in each specimen. The specimens underwent neuronavigation-assisted endoscopic SeIAH to confirm our surgical trajectory. WM dissection using Klingler's technique was performed on five specimens to assess WM integrity.
Results:
This approach allowed the identification of collateral eminence, lateral ventricular sulcus, choroid plexus, inferior choroidal point, amygdala, hippocampus, and fimbria. SelAH was successfully performed on all specimens, and CT neuronavigation confirmed the planned trajectory. WM dissection confirmed the integrity of language pathways and optic radiations.
Conclusions:
Endoscopic SelAH through the aMTG can be successfully performed with a corticectomy of 15 mm, presenting a reduced risk of vascular injury and damage to WM pathways. This could potentially help to reduce cognitive and visual deficits associated with SelAH.
Insights
This study demonstrates a new endoscopic technique for selective amygdalohippocampectomy (SelAH) through the anterior middle temporal gyrus (aMTG). This minimally invasive approach shows potential for reducing cognitive and visual deficits in patients with mesial temporal sclerosis.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Neuroanatomy
Background:
- Selective amygdalohippocampectomy (SelAH) is a common treatment for mesial temporal sclerosis.
- Microsurgical approaches carry risks of cognitive and visual deficits due to damage to white matter (WM) pathways.
Purpose of the Study:
- To evaluate the feasibility of an endoscopic approach for SelAH via the anterior middle temporal gyrus (aMTG).
Main Methods:
- Virtual simulation using MRI scans and cadaveric dissection on 22 specimens.
- Endoscopic access through a 1.5 cm corticectomy in the aMTG, 1.5 cm posterior to the temporal pole.
- Neuronavigation-assisted SelAH and WM dissection using Klingler's technique to assess pathway integrity.
Main Results:
- Successful endoscopic SelAH was performed in all specimens.
- Key anatomical structures including the amygdala and hippocampus were identified.
- Neuronavigation confirmed the trajectory, and WM dissection verified the integrity of language pathways and optic radiations.
Conclusions:
- Endoscopic SelAH through the aMTG is feasible with a small corticectomy (15 mm).
- This technique offers a reduced risk of vascular injury and WM pathway damage.
- Potential to mitigate cognitive and visual deficits associated with traditional SelAH.
