Hippocampal sclerosis is the most common cause of drug-resistant epilepsy amenable for surgical treatment and seizure control. The rationale of the selective amygdalohippocampectomy is to spare cerebral tissue not included in the seizure generator.
Describe the selective amygdalohippocampectomy through the trans-superior temporal gyrus keyhole approach.
Selective amygdalohippocampectomy for temporal lobe epilepsy is performed when the data (semiology, neuroimaging, electroencephalography) point to the mesial temporal structures. The trans-superior temporal gyrus keyhole approach is a minimally invasive and safe technique that allows disconnection of the temporal stem and resection of temporomesial structures.
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The authors thank Dr. Dominique Hasboun and Dr. Anne Bertrand (Department of Neuroradiology, La Pitié-Salpêtrière Hospital, Paris, France) for anatomical views and imaging.
Conflicts of interest
- Knowledge of mesial temporal lobe anatomy is fundamental.
- Place the retractor to secure an unobstructed view of the intraventricular mesial temporal lobe structures.
- Visualise the choroid plexus and the choroid fissure that are most important surgical landmarks.
- Subpial dissection technique is a key to all aspects of temporomesial epilepsy surgery.
- Be careful not to resect any tissue posterosuperior to the temporal horn to avoid damaging the fibres of Meyer’s loop.
- Take care not to extend the amygdala resection too superiorly into the globus pallidus.
- Perform the posterior disconnection at the level of the midbrain tectum.
- The hippocampal vessels typically can be separated from the hippocampus without coagulation.
- Haemostasis of the resection cavity is accomplished with Surgicel® and cottonoid packing.
- In postoperative period, antiepileptic drugs must be resumed at full dose.
Electronic supplementary material
Below is the link to the electronic supplementary material.
The video shows the major steps of a left selective amygdalohippocampectomy via trans-superior temporal gyrus keyhole approach. In our institution, the actual length of the whole procedure is 75 min on average (MP4 50.7 mb)
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Mathon, B., Clemenceau, S. Selective amygdalohippocampectomy via trans-superior temporal gyrus keyhole approach. Acta Neurochir 158, 785–789 (2016). https://doi.org/10.1007/s00701-016-2717-4
- Epilepsy surgery
- Hippocampal sclerosis
- Selective amygdalohippocampectomy
- Transcortical approach
- Mesial temporal lobe epilepsy