How do I do it? Selective amygdalohippocampectomy

Navigation-assisted trans-inferotemporal cortex selective amygdalohippocampectomy for mesial temporal lobe epilepsy

Purpose: To achieve satisfactory memory outcomes, we hypothesized that preserving the temporal stem might play an important role. To preserve the temporal stem, we developed a minimally invasive surgical procedure, “neuronavigation-assisted trans-inferotemporal cortex SAH” (TITC-SAH), performed via a small cortical incision in the middle or inferior temporal gyrus. We analyzed outcomes of the procedure in terms of both seizure control and memory function.

Methods: TITC-SAH was performed in 20 patients with MTLE. The inferior horn of the lateral ventricle was approached via the inferior or middle temporal gyrus along the inferior temporal sulcus under neuronavigation guidance. The hippocampus was dissected in a subpial manner and resected en bloc together with the parahippocampal gyrus. During follow-up for more than 1 year, seizure control in the first year of follow-up and memory function at 6 months postoperatively were evaluated using the International League Against Epilepsy (ILAE) classification system and Wechsler Memory Scale-Revised (WMS-R), respectively.

Results: One year after TITC-SAH, 17 of the 20 patients were seizure-free (ILAE class 1), 2 experienced auras only (ILAE class 2), and 1 experienced 3 seizures per year (ILAE class 3). Verbal memory improved significantly and improvements were seen regardless of whether the SAH was on the language-dominant or non-dominant hemisphere.

Conclusion: Navigation-assisted TITC-SAH performed for MTLE via a cortical incision in the middle or inferior temporal gyrus offers a simple, minimally invasive procedure that appears to yield excellent outcomes in terms of seizure control and improvement of memory function.