title: Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications.
abstract: BACKGROUND
  A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA), which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex.
  
  
  METHODS
  In this article, the authors describe technical nuances to improve the safety of SA.
  
  
  RESULTS
  Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation.
  
  
  CONCLUSIONS
  SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kovanda
authors.affiliation: Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
keywords: Epilepsy surgery; medial temporal lobe epilepsy; neurosurgical procedure; selective amygdalohippocampectomy; transsylvian