A follow-up study of surgery in temporal lobe epilepsy

Falconer, Murray A.; Serafetinides, E. A.

doi:10.1136/jnnp.26.2.154

Cited by 250 publications

(170 citation statements)

References 23 publications

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“…All these procedures, ranging from extensive temporal lobectomies to less invasive disconnections, share different degrees of cortical and white matter disruption near eloquent areas. 2,4,8,9,11,13,16 This drawback has limited the use of temporal approaches to resistant or late-stage pathological conditions after the function of the temporomesial structures is already impaired. In addition, lateral approaches to the temporal horn to treat pathological conditions affecting the dominant hemisphere are avoided.…”

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confidence: 99%

New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment

Sánchez

Rincón-Torroella

Prats-Galino

et al. 2014

JNS

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Object. The temporal horn of the lateral ventricle is a complex structure affected by specific pathological conditions. Current approaches to the temporal horn involve a certain amount of corticotomy and white matter disruption. Surgeons therefore set aside anterior temporal lobectomy as a last resource and avoid it in the dominant hemisphere. The authors propose a minimally invasive endoscopic intraventricular approach to the temporal horn and describe a standardized analysis and technical assessment of the feasibility of this approach.Methods. To determine the best trajectory, angulation, and entry point to the temporal horn of the lateral ventricle, the authors evaluated 50 cranial MRI studies (100 temporal lobes) from healthy patients. They studied and systematized the neurosurgical endoscopic anatomy. They also simulated the proposed approach in 9 cadaveric specimens (18 approaches).Results. Mean scalp entry point coordinates (± SD) were 2.7 ± 0.28 cm lateral to the inion and 5.6 ± 0.41 cm superior to the inion. The mean total distance from the uncal recess to the scalp (± SD) was 10.64 ± 0.6 cm. The mean total intraparenchymal distance crossed by the endoscope was 3.76 ± 0.36 cm. The approach was successfully completed in all studied specimens.Conclusions. In this study, the endoscopic intraventricular approach to the temporal horn is standardized. The morphometric analysis makes this approach anatomically feasible and replicable. This approach provides minimally invasive endoscopic access to the uncal recess, amygdala, hippocampus, fornix, and paraventricular temporal lobe structures. The following essential strategies enabled access to and maneuverability inside the temporal horn: tailored preoperative planning of the trajectory and use of anatomical and radiological references, constant irrigation, and an angled endoscopic lens. Safety assessment and novel instruments and techniques may be proposed to advance this very promising route to pathological changes in the temporal lobe.

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confidence: 99%

New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment

Sánchez

Rincón-Torroella

Prats-Galino

et al. 2014

JNS

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“…Cranial nerve palsies are a documented complication following temporal lobectomy, with dysfunction of the oculomotor and trochlear nerves noted in as many as 15% of cases 2,4,7,9 and facial nerve palsies in as many as 3% of cases. 1,10 These extraaxial CN palsies have been attributed to both direct and indirect injury corresponding to their anatomy.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal neuropathic pain as a complication of anterior temporal lobectomy: report of 2 cases

Gill¹,

Parrent

Steven

2016

JNS

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Cranial nerve (CN) deficits following anterior temporal lobectomy (ATL) are an uncommon but well-recognized complication. The usual CNs implicated in post-ATL complications include the oculomotor, trochlear, and facial nerves. To the authors’ knowledge, injury to the trigeminal nerve leading to neuropathic pain has not been previously described in the literature. This paper presents 2 cases of trigeminal neuropathic pain following temporal lobe resections for pharmacoresistant epilepsy. The possible pathophysiological mechanisms are discussed and the microsurgical anatomy of surgically relevant structures is reviewed.

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“…M. Falconer в 1963 г. [8] описал революционную методику передней височной лобэктомии, которая заключалась в резекции конвекситальных отделов височной доли на 4 см от полюса на доминантной стороне и на 6 см на субдоминантной и удалении ла-теральных отделов миндалевидного тела и передних отделов гиппокампа. В настоящее время данная ме-тодика применяется в модификации, которая пред-полагает расширенную резекцию медиальных структур, включая задние отделы гиппокампа [9].…”

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