Safety of the paramedian supracerebellar–transtentorial approach for selective amygdalohippocampectomy

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The goal of this study was to assess the reproducibility and safety of the recently introduced paramedian supracerebellar–transtentorial (PST) approach for selective amygdalohippocampectomy (SA).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective analysis of prospectively collected data originating from their surgical register of patients undergoing SA via a PST approach for lesional medial temporal lobe epilepsy. All patients received thorough pre- and postoperative clinical (neurological, neuropsychological, psychiatric) and instrumental (ictal and long-term EEG, invasive EEG if needed, MRI) workup. Surgery-induced complications were assessed at discharge and at every follow-up thereafter and were classified according to Clavien-Dindo grade (CDG). Epilepsy outcome was defined according to Engel classification. Data were reported according to common descriptive statistical methods.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Between May 2015 and May 2018, 17 patients underwent SA via a PST approach at the authors’ institution (hippocampal sclerosis in 13 cases, WHO grade II glioma in 2 cases, and reactive gliosis in 2 cases). The median postoperative follow-up was 7 months (mean 9 months, range 3–19 months). There was no surgery-related mortality and no complication (CDG ≥ 2) in the whole series. Transitory CDG 1 surgical complications occurred in 4 patients and had resolved in all of them by the first postoperative follow-up. One patient showed a deterioration of neuropsychological performance with new slight mnestic deficits. No patient experienced a clinically relevant postoperative visual field defect. No morbidity due to semisitting position was recorded. At last follow-up 13/17 (76.4%) patients were in Engel class I (9/17 [52.9%] were in class IA).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The PST approach is a reproducible and safe surgical route for SA. The achievable complication rate is in line with the best results in the literature. Visual function outcome particularly benefits from this highly selective, neocortex-sparing approach. A larger patient sample and longer follow-up will show in the future if the seizure control rate and neuropsychological outcome also compare better than those achieved with current common surgical techniques.</jats:p></jats:sec>

A Novel Sublabial Anterior Transmaxillary Approach for Medically Refractory Mesial Temporal Lobe Epilepsy: A Comparative Anatomic Study

“…However, the trajectory is technically demanding (not different than the current described approach), but fraught with critical neurovascular structures, as evidenced by an approximately 20% incidence of immediate postoperative cranial nerve palsy. 48,65 The approach has also technical challenges in addressing the more anterior aspects of mesial temporal lobe resections, in particular, the temporal pole areas. In addition, the transmaxillary approach is conversely oriented parallel to the structures in question to allow for a "down the barrel" resection.…”

Sex-related differences in postoperative complications following elective craniotomy for intracranial lesions: An observational study

“…Furthermore, postoperative complications were not collected prospectively and systematically with a recognized score such as the Clavien-Dindo classification, which has been validated for multiple neurosurgical conditions. [39–42]…”

“…Furthermore, postoperative complications were not collected prospectively and systematically with a recognized score such as the Clavien-Dindo classification, which has been validated for multiple neurosurgical conditions. [39][40][41][42] Finally, comorbidities were not summarized organ-specifically, as we did. Our approach thus reduces the risk of underestimation of the real frequency of postoperative complications and comorbidities.…”

Visual field defects in temporal lobe epilepsy surgery

“…The mesial temporal lobe structures including the parahippocampal gyrus are then resected 32 . This technique uniquely has the benefit of preventing any unnecessary brain resection or retraction and recent series have reported no VFD rates with seizure freedom rates comparable to the other surgical techniques 33 . It should be noted that the position of the torcula and consequently the angle of the tentorium in some patients may preclude this technique.…”