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Acta Neurochirurgica

, Volume 155, Issue 12, pp 2381–2387 | Cite as

How I do it – selective amygdalohippocampectomy via subtemporal approach

  • Tomislav Sajko
  • Ivan ŠkoroEmail author
  • Krešimir Rotim
How I Do it - Neurosurgical Techniques

Abstract

Background

Surgery is superior over medicamentous treatment of pharmacoresistant mesial temporal lobe epilepsy caused by hippocampal sclerosis. The armamentarium of surgical procedures comprises standard temporal lobectomy and more selective procedures. Selective amygdalohippocampectomy can be performed via transcortical, transsylvian or subtemporal approach.

Method

Describe the selective amygdalohippocampectomy through the subtemporal approach

Conclusion

After the detailed preoperative epilepsy evaluation, surgery can be offered to pharmacoresistant epilepsy patient with hippocampal sclerosis. Selective amygdalohippocampectomy can be safely performed through the subtemporal approach. The good knowledge of the mesial temporal lobe anatomy is necessary when performing this procedure.

Key points

• Perform the subtemporal craniotomy with additional bone removal up to temporal petrous part to minimize retraction of the brain.

• Release the CSF from the subarachnoid sulcal space in order to relax the temporal lobe. Dissect the arachnoid around basal temporal veins and protect them with hemostatic material in order to avoid vein rupture.

• After gyrus fusiformis corticotomy, always follow the white matter in order to enter the temporal horn.

• Place the self-retraining retractor gently to secure an unobstructed view of the intraventricular mesial temporal lobe structures.

• Visualize the choroid plexus and the inferior choroidal point. They represent the two most important landmarks.

• While performing the anterior disconnection the goal is to reach the arachnoid of the interpeduncular and crural cistern medially and the tentorial edge laterally.

• Follow the tentorial edge and the arachnoid of the temporal base to securely perform the lateral disconnection.

• Perform the posterior disconnection at the level of the mesencephalon superior colliculi.

• During the medial disconnection the dissection of the arachnoid of the hippocampal sulcus must be done as close to the hippocampus as possible in order to avoid damage to the brain stem perforators or the loop of the anterior choroidal artery.

• Knowledge of mesial temporal lobe anatomy is crucial.

Keywords

Pharmacoresistant epilepsy Hippocampal sclerosis Selective amygdalohippocampectomy Subtemporal approach 

Notes

Acknowledgments

Authors would like to express their gratitude to Mrs. Maja Mravec for her help in illustrating Figs. 1 and 2.

Conflicts of interest

None.

Supplementary material

ESM 1

(MPG 28826 kb)

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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Department of Neurosurgery“Sestre milosrdnice” University Hospital CenterZagrebCroatia

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