Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy

Abstract

Background: Selective amygdalohippocampectomy is one of the main approaches for treating medial temporal lobe epilepsy (TLE). We herewith describe seven cases of amygdala lesions treated with selective amygdalectomy with the hippocampus saving procedure. Furthermore, we explain the trans-middle temporal gyrus transventricular approach for selective amygdalectomy. Methods: We studied patients with TLE who underwent selective amygdalectomy with hippocampal saving procedure between March 2012 and July 2018. We preferred the trans-middle temporal gyrus transventricular approach. We adopted pterional craniotomy with extensive exposure of the base and posterior of the temporal lobe. The posterior margin of resection in the intraventricular part of the amygdala was considered the inferior choroidal point. Medially anterior part of the uncus was resected until reaching the ambient cistern. We applied the transcortical transventricular approach for selective amygdalectomy in all patients. Results: We present 11 cases having an amygdala lesion in our series, seven of whom underwent selective amygdalectomy with hippocampal sparing. Nine patients had neoplastic lesions, and in two of them, gliosis was evident. Total resection of the lesion was achieved in all cases based on postoperative magnetic resonance imaging. No unusual complication or surgically-related new neurological deficit occurred. Conclusion: We consider the resection of the amygdala until the inferior choroidal point sufficient for the disconnection of its circuits, which results in more effective control of seizures and reduction of surgery time and complications.

Exacerbation of restless legs syndrome following amygdalohippocampectomy: A case report

“…Complications after amygdalohippocampal resection have been reported, including cerebrovascular disorders and memory impairment. 4 However, to the best of our knowledge, no reports highlighting RLS exacerbations exist.…”

“…These results strongly suggest that the resection of the left hippocampus or amygdala is the primary cause of RLS exacerbation. Complications after amygdalohippocampal resection have been reported, including cerebrovascular disorders and memory impairment 4 . However, to the best of our knowledge, no reports highlighting RLS exacerbations exist.…”

“…The incidence of RLS in Japan is estimated to be 1%–4% 2,3 . Complications after amygdalohippocampectomy have been reported, including cerebrovascular disorders and memory impairment 4 . However, no reports are available on the exacerbation of RLS after amygdalohippocampectomy.…”

“… 2 , 3 Complications after amygdalohippocampectomy have been reported, including cerebrovascular disorders and memory impairment. 4 However, no reports are available on the exacerbation of RLS after amygdalohippocampectomy. In this study, we present a case in which the symptoms worsened on the fifth day after a left‐sided amygdalohippocampectomy, particularly in the lower limbs and back, mainly on the right side.…”

Cortical incisions and transcortical approaches for intra-axial and intraventricular lesions: A scoping review

“…Table 1 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][21][22][23][24][25][26][27][28][29][30][32][33][34][35][37][38][39][40][41][42][43][44][45][46][47][48][50][51][52][53][54][55][56][57] summarizes the demographics, pathology, and surgical anatomy of all 2604 pooled patients. Age ranged from 5 to 80 years, with a male prevalence of 57.78% [ 1237 cases, most frequently located on the left side (57.15%), followed by the right side (42.84%).…”