Keyhole epilepsy surgery: corticoamygdalohippocampectomy for mesial temporal sclerosis.
Surgical approaches for medically refractory mesial temporal lobe epilepsy (MTLE) that previously have been reported include anterior temporal lobectomy (ATL), transcortical selective amygdalohippocampectomy, transsylvian amygdalohippocampectomy, and subtemporal amygdalohippocampectomy. Each approach has its advantages and potential pitfalls. The purpose of this report is to describe our technique of keyhole corticoamygdalohippocampectomy for patients with MTLE due to hippocampal sclerosis. Operations were performed through a 6-cm vertical linear incision and a low 2.5-cm keyhole craniotomy at the anterior squamous temporal bone. Resection of the anterior-most portions of the middle and inferior temporal gyri provided a cylinder-like corridor to the mesial temporal lobe. Identification of the temporal horn through a basal approach was followed by resection of the amygdala, uncus, and hippocampus-parahippocampal gyrus. This 9-year series included 683 patients with a minimum follow-up duration of 2 years. Surgery times were short (range, 1 h 35 min to 2 h 30 min). Only a small percentage of patients had complications (1.76%), and the rate of Engel Class I seizure-free outcome was 87%. No overt speech problems or visual field deficits were identified. Compared with the most popular conventional trans-middle temporal gyrus approach, this technique can make the operation easier, safer, and less traumatic to functional lateral neocortex.
Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, North Road 156, West, Second Ring, Fuzhou, 350025, China. neurosurg.yang@163.com.
Peng-Fan
PF
Yang
Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, North Road 156, West, Second Ring, Fuzhou, 350025, China.
Hui-Jian
HJ
Zhang
Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, North Road 156, West, Second Ring, Fuzhou, 350025, China.
Jia-Sheng
JS
Pei
Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China.
Qiao
Q
Lin
Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China.
Zhen
Z
Mei
Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China.
Zi-Qian
ZQ
Chen
Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China.
Yan-Zeng
YZ
Jia
Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China.
Zhong-Hui
ZH
Zhong
Department of Pathology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China.
Zhi-Yong
ZY
Zheng
D000679:Amygdala / Q000601:surgery*; D002540:Cerebral Cortex / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery; D003399:Craniotomy; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007361:Intelligence Tests; D008279:Magnetic Resonance Imaging; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D012598:Sclerosis; D013701:Temporal Bone / Q000601:surgery; D016896:Treatment Outcome; D014794:Visual Fields
Corticoamygdalohippocampectomy; Hippocampal sclerosis; Keyhole craniotomy; Mesial temporal lobe epilepsy; Seizure outcome