Anterior temporal lobectomy is the most established neurosurgical procedure for temporal lobe epilepsy. Here we describe this technique.
A temporal craniotomy is performed flush with the middle fossa and exposing the Sylvian fissure. The posterior extent of resection is determined as 4.5 cm in the dominant temporal lobe and 5.5 cm in the nondominant one. The first stage consists of removing the lateral neocortex and part of the fusiform gyrus, parallel to the Sylvian fissure, while keeping the temporal horn as the medial limit in the coronal plane. Then, the amygdala, uncus, fimbriae, hippocampus and collateral eminence are identified, transected and resected with the parahippocampal gyrus to complete the procedure.
Knowledge of the temporomesial anatomy, including neurovascular structures around the brainstem, is essential to keep this procedure safe and effective.
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Conflicts of interest
All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
10 key points
- Positioning: Horizontal
- Craniotomy: Strictly temporal with clear exposure of the Sylvian fissure
- Clear demarcation of the resection zone
- Lateral neocortical en bloc temporal resection
- Stop medial dissection after opening of the temporal horn to preserve mesial structures
- Identification of mesial structures as relevant anatomical landmarks
- Resection of the amygdala and uncus
- Hippocampal isolation by transection of the collateral eminence down to the arachnoid level and resection of the parahippocampal gyrus
- Resection of the fimbria
- Hippocampal resection by disconnection from its mesentery
Electronic supplementary material
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A right temporal craniotomy is performed exposing the floor of the middle fossa and Sylvian fissure, and the posterior limit of resection is determined at 5.5 cm from the temporal pole. Using ultrasonic aspiration, resection of the lateral temporal neocortical block is performed after identification of the temporal ventricular horn, followed by the resection of the uncus, fimbria, hippocampus and parahippocampal gyrus. (M4V 80277 kb)
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Schaller, K., Cabrilo, I. Anterior temporal lobectomy. Acta Neurochir 158, 161–166 (2016). https://doi.org/10.1007/s00701-015-2640-0
- Anterior temporal lobectomy
- Epilepsy surgery