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Endoscopic endonasal approach to the mesial temporal lobe: anatomical study and clinical considerations for a selective amygdalohippocampectomy

Acta Neurochirurgica volume 162, pages 881–891 (2020)Cite this article

Abstract

Background

Selective amygdalohippocampectomy (AH) is a surgical option for patients with medically intractable seizures from mesial temporal lobe pathology. The transcranial route is considered the best method to achieve this goal. However, the standard approach through the neocortex is still invasive. The risks can be minimized if the mesial temporal lobe is resected while preserving the lateral temporal lobe and the Meyer’s loop. This study explores the feasibility of selective AH by endoscopic endonasal approach (EEA) in cadaveric specimens.

Methods

The endoscopic anatomy of the mesial temporal lobe and the feasibility of a successful selective AH were studied in six hemispheres from three injected human cadavers. Quantitative analyses on the extent of resection and angles of exposure were performed based on CT and MRI studies of pre- and post-selective AH and measurements taken during dissections.

Results

The EEA V1-V2 corridor provided a direct and logical line of access to the mesial temporal lobe, following its natural trajectory with no brain retraction and minimal exposure of the pterygopalatine fossa. The components of the mesial temporal lobe were resected just as selectively and easily as the transcranial route, but without compromising the structures of the lateral temporal lobe or the Meyer’s loop.

Conclusions

The EEA V1-V2 corridor demonstrated its selective resectability and accessibility of the mesial temporal lobe in cadaveric specimens. The clinical value of this approach should be explored responsibly by a surgeon with both competent microsurgical skills and experiences in EEA.

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Authors and Affiliations

  1. Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France

    Hun Ho Park, Daniel Ronconi, Shunya Hanakita, Kentaro Watanabe, Moujahed Labidi, Anne-Laure Bernat & Sébastien Froelich

  2. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea

    Hun Ho Park

  3. Paris VII-Diderot University, Paris, France

    Sébastien Froelich

Authors
  1. Hun Ho Park
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  2. Daniel Ronconi
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  3. Shunya Hanakita
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  4. Kentaro Watanabe
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  5. Moujahed Labidi
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  6. Anne-Laure Bernat
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  7. Sébastien Froelich
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Correspondence to Sébastien Froelich.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For the following retrospective study, formal consents are not required.

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Informed consent was obtained from all individual participants included in the study. No identifiable information is available in the article. This article does not contain any studies with human participants performed by any of the authors.

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This article is part of the Topical Collection on Neurosurgical Anatomy

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Park, H.H., Ronconi, D., Hanakita, S. et al. Endoscopic endonasal approach to the mesial temporal lobe: anatomical study and clinical considerations for a selective amygdalohippocampectomy. Acta Neurochir 162, 881–891 (2020). https://doi.org/10.1007/s00701-019-04163-1

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  • DOI: https://doi.org/10.1007/s00701-019-04163-1

Keywords

  • Endoscopic endonasal approach
  • Mesial temporal lobe
  • Meyer’s loop
  • Selective amygdalohippocampectomy
  • Temporal lobe epilepsy