[Hippocampal microsurgical anatomy regarding the selective amygdalohippocampectomy in the Niemeyer's technique perspective and preoperative method to maximize the corticotomy].
The deep knowledge of hippocampal microsurgical anatomy is paramount in epilepsy surgery. One of the most used techniques is those proposed by Niemeyer.


OBJECTIVE
To describe the hippocampal anatomy in detail and to present a technique in which preoperative anatomical points in MRI are identified to guide the corticotomy.


METHODS
Microsurgical dissections were performed in twenty brain hemispheres and eight cadaveric heads to identify temporal lobe and hippocampus structures. Thirty two patients with drug-resistant temporal lobe epilepsy underwent a selective amygdalohippocampectomy with Niemeyer's technique being measured three preoperative MRI preoperative distances to guide the corticotomy.


RESULTS
The hippocampus was divided in head, body and tail and its microsurgical anatomy described in detail. The MRI measurements are presented and discussed.


CONCLUSIONS
The knowledge of the complex anatomy of the hippocampus can be achieved in a three-dimensional way during microsurgical dissections. The preoperative MRI measurement is a reasonable guide to perform temporal corticotomy in Niemeyer's technique.
Isolan
Gustavo Rassier
GR
Programa da Cirurgia da Epilepsia, Departamento de Neurocirurgia, Hospital São Lucas, Universidade Católica do Rio Grande do Sul, Rua Ramiro Barcelos 2171/31, Porto Alegre, RS, Brazil. gisolan@yahoo.com.br
Azambuja
Ney
N
Paglioli Neto
Eliseu
E
Paglioli
Eduardo
E
D000679:Amygdala / Q000033:anatomy & histology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D006624:Hippocampus / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008866:Microsurgery / Q000379:methods; D011446:Prospective Studies