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Burr hole microsurgical subtemporal selective amygdalohippocampectomy

  • Original Article - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

Introduction

At present, selective amygdalohippocampectomy (SAH) has become popular in the treatment of drug-resistant mesial temporal lobe epilepsy (TLE). However, there is still an ongoing discussion about the advantages and disadvantages of this approach.

Methods

The study included a consecutive series of 43 adult patients with drug-resistant TLE, involving 24 women and 19 men (1.8/1). Surgeries were performed at the Burdenko Neurosurgery Center from 2016 to 2019. To perform subtemporal SAH through the burr hole with the diameter of 14 mm, we used two types of approaches: preauricular, 25 cases, and supra-auricular, 18 cases. The follow-up ranged from 36 to 78 months (median 59 months). One patient died 16 months after surgery (accident).

Results

By the third year after surgery, Engel I outcome was achieved in 80.9% (34 cases) of cases and Engel II in 4 (9.5%) and Engel III and Engel IV in 4 (9.6%) cases. Among the patients with Engel I outcomes, anticonvulsant therapy was completed in 15 (44.1%), and doses were reduced in 17 (50%) cases. Verbal and delayed verbal memory decreased after surgery in 38.5% and 46.1%, respectively. Verbal memory was mainly affected by preauricular approach in comparison with supra-auricular (p = 0.041). In 15 (51.7%) cases, minimal visual field defects were detected in the upper quadrant. At the same time, visual field defects did not extend into the lower quadrant and inside the 20° of the upper affected quadrant in any case.

Conclusions

Burr hole microsurgical subtemporal SAH is an effective surgical procedure for drug-resistant TLE. It involves minimal risks of loss of visual field within the 20° of the upper quadrant. Supra-auricular approach, compared to preauricular, results in a reduction in the incidence of upper quadrant hemianopia and is associated with a lower risk of verbal memory impairment.

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Authors and Affiliations

  1. N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia

    David Pitskhelauri, Elina Kudieva, Pavel Vlasov, Natalya Eliseeva, Oleg Zaitsev, Maria Kamenetskaya, Antonina Kozlova, Ludmila Shishkina, Gleb Danilov, Alexander Sanikidze, Ruslan Ishkinin & Armen Melikyan

  2. Sechenov University, Moscow, Russia

    Tekla Kuprava

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Correspondence to David Pitskhelauri.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of Burdenko Neurosurgery Institute and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors have no personal, financial, or institutional interest in any of the drugs and materials, described in this article. Dr. Pitskhelauri is the inventor of the Mari device and has ownership in Tolikety Co., Ltd., the company that manufactures the Mari device.

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Pitskhelauri, D., Kudieva, E., Vlasov, P. et al. Burr hole microsurgical subtemporal selective amygdalohippocampectomy. Acta Neurochir 165, 1215–1226 (2023). https://doi.org/10.1007/s00701-023-05536-3

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