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How I do it – selective amygdalohippocampectomy via a navigated temporobasal approach, when veins forbid elevation of the temporal lobe

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Abstract

Background

Selective amygdalohippocampectomy is an effective treatment option for mesial temporal lobe epilepsy associated with hippocampal sclerosis.

Methods

To describe and emphasize potential pitfalls during selective amygdalohippocampectomy via a modified navigated temporobasal approach, in cases, where temporal basal veins hinder the required elevation of the temporal lobe.

Conclusions

Selective amygdalohippocampectomy via navigated temporobasal approach is a safe procedure that can reduce the rate of visual field deficits by avoiding damage of optic radiation. The option of a small subpial corticotomy of the inferior temporal gyrus allows sufficient elevation of the temporal lobe in cases with difficult basal venous anatomy.

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Acknowledgements

We thank Dr. Christian Scheiwe for providing the video.

Author information

Correspondence to Hans Clusmann.

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Conflicts of interest

None.

Electronic supplementary material

The video shows the surgical technique of performing a selective amygdalohippocampectomy on the right via temporobasal approach in a case, where the basal veins hinder the retraction of the temporal lobe. In order to do that, a small corticotomy is performed on the more lateral and inferior aspect of the inferior temporal gyrus. Thus, the veins remain attached to the temporal base and the temporal horn can be reached slightly upward. Upon entering the ventricle, the amygdalum is resected. After that an en block removal of the right hippocampus is performed. (MP4 295,316 kb)

ESM 1

The video shows the surgical technique of performing a selective amygdalohippocampectomy on the right via temporobasal approach in a case, where the basal veins hinder the retraction of the temporal lobe. In order to do that, a small corticotomy is performed on the more lateral and inferior aspect of the inferior temporal gyrus. Thus, the veins remain attached to the temporal base and the temporal horn can be reached slightly upward. Upon entering the ventricle, the amygdalum is resected. After that an en block removal of the right hippocampus is performed. (MP4 295,316 kb)

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Delev, D., Schramm, J. & Clusmann, H. How I do it – selective amygdalohippocampectomy via a navigated temporobasal approach, when veins forbid elevation of the temporal lobe. Acta Neurochir 160, 597–601 (2018). https://doi.org/10.1007/s00701-017-3386-7

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Keywords

  • Selective amygdalohippocampectomy
  • Subtemporal
  • Temporobasal
  • Veins
  • Epilepsy
  • Hippocampal sclerosis