Subtemporal Hippocampectomy Preserving the Basal Temporal Language Area for Intractable Mesial Temporal Lobe Epilepsy: Preliminary Results

Mikuni, Nobuhiro; Miyamoto, Susumu; Ikeda, Akio; Satow, Takeshi; Taki, Junya; Takahashi, Jun; Ohigashi, Yoshitaka; Hashimoto, Nobuo

doi:10.1111/j.1528-1167.2006.00610.x

Cited by 34 publications

(21 citation statements)

References 41 publications

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“…The need to incise, resect, or retract the temporal or occipital lobes during surgery of the MTR is a controversial issue. 1,3,4,[8][9][10]12,13,15,20,26,27,29,30,33,[35][36][37][38][42][43][44][45][46][47][48]50,[57][58][59]67 This enclosed and extended localization near these highly significant structures renders the MTR a difficult surgical area in some respects. This location necessitates the least traumatic approach without the risk of injury to overlying…”

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confidence: 99%

The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study

Türe

Harput²,

Kaya³

et al. 2012

JNS

108

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ObjectThe exploration of lesions in the mediobasal temporal region (MTR) has challenged generations of neurosurgeons to achieve an appropriate approach. To address this challenge, the extensive use of the paramedian supracerebellar-transtentorial (PST) approach to expose the entire length of the MTR, as well as the fusiform gyrus, was investigated.MethodsThe authors studied the microsurgical aspects of the PST approach in 20 cadaver brains and 5 cadaver heads under the operating microscope. They evaluated the features, advantages, difficulties, and limitations of the PST approach and refined the surgical technique. They then used the PST approach in 15 patients with large intrinsic MTR tumors (6 patients), tumor in the posterior fusiform gyrus with mediobasal temporal epilepsy (MTE) (1 patient), cavernous malformations in the posterior MTR including the fusiform gyrus (2 patients), or intractable MTE with hippocampal sclerosis (6 patients) from December 2007 to May 2010. Patients ranged in age from 11 to 63 years (mean 35.2 years), and in 9 patients (60%) the lesion was located on the left side.ResultsIn all patients with neuroepithelial tumors or cavernous malformations, the lesions were completely and safely resected. In all patients with intractable MTE with hippocampal sclerosis, the anterior two-thirds of the parahippocampal gyrus and hippocampus, as well as the amygdala, were removed selectively through the PST approach. There was no surgical morbidity or mortality in this series. Three patients (20%) with high-grade neuroepithelial tumors underwent postoperative radiotherapy and chemotherapy but needed a second surgery for recurrence during the follow-up period. In all patients with MTE, antiepileptic medication could be decreased to a single drug at lower doses, and no seizure activity has occurred until this point.ConclusionsThe PST approach provides the surgeon precise anatomical orientation when exposing the entire length of the MTR, as well as the fusiform gyrus, for removing any lesion. This is a novel technique especially for removing tumors involving the entire MTR in a single session without damaging neighboring neural or vascular structures. This approach can also be a viable alternative for selective removal of the parahippocampal gyrus, hippocampus, and amygdala in patients with MTE due to hippocampal sclerosis.

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mentioning

confidence: 99%

The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study

Türe

Harput²,

Kaya³

et al. 2012

JNS

108

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“…Among them are the fusiform gyrus, left inferior frontal gyrus, and parahippocampal gyrus (Weis et al, 2004), the entorhinal cortex (Higuchi and Miyashita, 1996), and the anterior cingulate cortex (Frankland et al, 2004, Einarsson and Nader, 2012). Stimulation using subdural electrodes during object naming in patients with temporal lobe epilepsy (Mikuni et al, 2006) has demonstrated that two of these regions, i.e. the fusiform and parahippocampal gyri of the dominant hemisphere, belong to a basal temporal language area , which plays a role in both object naming and verbal memory.…”

Section: Discussionmentioning

confidence: 99%

Activation of dominant hemisphere association cortex during naming as a function of cognitive performance in mild traumatic brain injury: Insights into mechanisms of lexical access

Popescu

Hughes

Popescu

et al. 2017

NeuroImage: Clinical

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Patients with a history of mild traumatic brain injury (mTBI) and objective cognitive deficits frequently experience word finding difficulties in normal conversation. We sought to improve our understanding of this phenomenon by determining if the scores on standardized cognitive testing are correlated with measures of brain activity evoked in a word retrieval task (confrontational picture naming). The study participants (n = 57) were military service members with a history of mTBI. The General Memory Index (GMI) determined after administration of the Rivermead Behavioral Memory Test, Third Edition, was used to assign subjects to three groups: low cognitive performance (Group 1: GMI ≤ 87, n = 18), intermediate cognitive performance (Group 2: 88 ≤ GMI ≤ 99, n = 18), and high cognitive performance (Group 3: GMI ≥ 100, n = 21). Magnetoencephalography data were recorded while participants named eighty pictures of common objects. Group differences in evoked cortical activity were observed relatively early (within 200 ms from picture onset) over a distributed network of left hemisphere cortical regions including the fusiform gyrus, the entorhinal and parahippocampal cortex, the supramarginal gyrus and posterior part of the superior temporal gyrus, and the inferior frontal and rostral middle frontal gyri. Differences were also present in bilateral cingulate cortex and paracentral lobule, and in the right fusiform gyrus. All differences reflected a lower amplitude of the evoked responses for Group 1 relative to Groups 2 and 3. These findings may indicate weak afferent inputs to and within an extended cortical network including association cortex of the dominant hemisphere in patients with low cognitive performance. The association between word finding difficulties and low cognitive performance may therefore be the result of a diffuse pathophysiological process affecting distributed neuronal networks serving a wide range of cognitive processes. These findings also provide support for a parallel processing model of lexical access.

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“…Over the last decades, more selective resections have been performed to spare neocortical brain tissue not involved in epilepsy pathology. Subtemporal, transcortical, and transsylvian approaches are used for SAH . The rates of seizure freedom are reported to be between 62% and 78% in different series .…”

Section: Discussionmentioning

confidence: 99%

Vascular events after transsylvian selective amygdalohippocampectomy and impact on epilepsy outcome

Martens

Merkel²,

Holst

et al. 2014

Epilepsia

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SUMMARYObjective: Epilepsy surgery is a standard treatment option for medically intractable temporal lobe epilepsy. Selective amygdalohippocampectomy (SAH) and anterior temporal lobectomy (ATL) are two of the standard surgical procedures in these cases. We conducted a retrospective analysis of patients treated with SAH via a modified transsylvian approach in our epilepsy center between 2008 and 2011, and we analyzed the impact of adjacent procedure-related infarctions on seizure outcome in these patients. Methods: Infarctions were detected by magnetic resonance imaging (MRI) within the first week postoperatively and by a second MRI 9 months after surgical intervention. Neuropsychological testing was performed preoperatively. Evaluation of seizure outcome and postoperative neuropsychological testing were conducted approximately 1 year after epilepsy surgery. Correlative clinical data were analyzed by retrospective chart review. Results: The postoperative MRI revealed temporal infarctions in 47.9% (n = 23/48) and frontal infarctions in 10.4% (n = 5/48) of the patients. These vascular events were asymptomatic in terms of focal neurologic deficits. Of the patients, 68.5% (n = 37/54) were free of disabling seizures (Engel class I) 1 year after the procedure. Patients with temporal infarctions were significantly more often free of disabling seizures (Engel class I, p = 0.046) than patients without temporal infarctions. Neuropsychological testing indicated a deterioration in verbal memory after SAH in patients with infarctions on the language-lateralized hemisphere compared to patients without infarction (p = 0.011). All other tested neuropsychological categories showed no significant differences between patients with or without infarctions. Significance: Our results indicate a surprisingly high number of procedure-related temporal infarctions after transsylvian SAH. Hence, the volume of nonfunctional "eliminated" tissue is enlarged unintentionally, which is a possible explanation for better seizure outcome in these patients. This result supports the notion that ATL is the favorable procedure for temporal lobe epilepsy compared to SAH in the nondominant hemisphere, as neuropsychological deficits are rarely to be expected.

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Subtemporal Hippocampectomy Preserving the Basal Temporal Language Area for Intractable Mesial Temporal Lobe Epilepsy: Preliminary Results

Cited by 34 publications

References 41 publications

The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study

The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study

Activation of dominant hemisphere association cortex during naming as a function of cognitive performance in mild traumatic brain injury: Insights into mechanisms of lexical access

Vascular events after transsylvian selective amygdalohippocampectomy and impact on epilepsy outcome

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