How I do it

Minimally invasive anterior temporal lobectomy with linear skin incision based on SEEG findings

• • Based on the stereotactically implanted depth EEG recording of interictal and ictal activity, in this medically intractable right temporal lobe epileptic patient, the extent of removal is planned to remove temporal lobe as indicated yellow line in Fig. 1, and linear skin incision in Fig. 1 is supposed to be sufficient to accomplish anterior temporal lobectomy.

• • In order to get into the temporal horn in this patient, superior temporal sulcus (STS) is selected to reach the base of STS, and then rostrocaudal suction of white matter (temporal stem) will be able to open temporal horn. After opening the temporal horn widely, lateral part of the temporal cortex (middle temporal, inferior temporal and fusiform gyri) is planned to remove en bloc, then medial part of the temporal cortex including hippocampus anterior to the choroidal point, and finally basolateral part of the amygdala and uncus are planned to be removed in piecemeal fashion without opening arachnoid membrane covering oclulomotor nerve, posterior cerebral artery, anterior choroidal artery and basal vein.