Subtemporal Amygdalohippocampectomy for Treating Medically Intractable Temporal Lobe Epilepsy

Abstract

A SUBTEMPORAL AMYGDALOHIPPOCAMPECTOMY technique has been developed for mesial temporal lobe epilepsy. The conventional subtemporal approach has been modified to diminish temporal lobe retraction and the risk of damage to the temporal lobe. In the new technique, the surgeons' position has moved from above to below and the approach has been changed from anterolateral to posterolateral, thereby avoiding the voluminous and steeply inclined anterior temporal lobe. By this modified approach, it was unnecessary to remove the roof of the external auditory meatus and it was estimated that both the retraction pressure and the extent of temporal lobe retraction were reduced. To date, surgeons using this approach have operated on four patients with temporal lobe epilepsy whose epileptic foci were in the mesial temporal structure; the inferior temporal gyrus, the temporal tip, the vein of Labbé, and the ventral bridging veins were preserved. After surgery, two patients became completely free of seizures and the other two showed over 90% reduction in seizure frequency without neurological sequelae. Postoperative visual field examination revealed full visual fields without quadrantanopsia. This approach can preserve the temporal stem and lateral temporal lobe, it can be used to remove as much of the posterior hippocampus as necessary, and it can be extended to conventional lobectomy if it is indicated.

Laser ablation therapy: An alternative treatment for medically resistant mesial temporal lobe epilepsy after age 50

“…Patients who undergo surgical treatment have better outcomes in terms of quality of life compared with medically treated patients and exhibit marked improvements in psychosocial adaptation [22,23,24]. More selective approaches to temporal lobe epilepsy have been developed with the potential advantage of improving postoperative neuropsychological performance [16,25,26]. However, despite surgical advances, patients greater than 50 years of age usually have more comorbidities and may be at an increased risk of surgical complication [6,7].…”

Role of proton magnetic resonance spectroscopy in preoperative evaluation of patients with mesial temporal lobe epilepsy

“…Surgery was done within 2 to 38 weeks (mean, 11 ± 9 weeks; median, 7 weeks) after 1 H-MRS. Subtemporal selective amygdalohippocampectomy (SAHE) [7,39] was performed in 8 cases, SAHE with lesionectomy in 6 cases, lesionectomy in 3 cases, and anterior temporal lobe resection in 1 case. All tumors underwent more than 95% removal.…”

Microsurgical Anatomy of the Supracerebellar Transtentorial Approach to the Posterior Mediobasal Temporal Region

“…One of the drawbacks of this approach is damage to the optic radiation. The subtemporal approach is another alternative to the mediobasal temporal region (6,10). The disadvantage of the subtemporal approach is the extensive retraction on the temporal lobe, which could lead to vein of Labbe injury and compromise of language areas in the dominant hemisphere.…”