title: Clinical and Imaging Evaluation of Transuncus Selective Amygdalohippocampectomy.
abstract: BACKGROUND
  Various reports have described the transuncus (TU) approach as a selective route to the amygdala and hippocampus, but this approach has not yet been submitted to solid postoperative imaging analysis. The objective of this study was to evaluate the anatomy, surgical technique, postoperative imaging analysis, and outcome in a series of patients with temporal lobe epilepsy who underwent selective amigdalohippocampectomy via a TU approach.
  
  
  METHODS
  This was a prospective study of 25 consecutive patients who underwent selective amigdalohippocampectomy through a TU approach. The temporal stem and temporal pole were evaluated through different modalities of 3-Tesla magnetic resonance imaging, including tractography of optic radiation (OR), uncinate fascicle, and inferior fronto-occipital fascicle. Visual field analysis was performed with automated perimetry.
  
  
  RESULTS
  The mean age was 40 ± 8.21 years, and mean follow-up was 26.44 + 12.58 months. Postoperatively, 21 patients (84%) were classified as Engel I (good seizure control). Diffusion tensor imaging (DTI) data showed that 78.2% of patients had some structural damage to the temporal stem and fibers of the uncinate fascicle were identified postoperatively in only 3 patients (13.04%). The inferior fronto-occipital fascicle was identified in 18 patients (78.3%); however, subsequent DTI analysis of the remaining fibers showed them to be damaged. Integrity of the OR did not differ between these 2 groups.
  
  
  CONCLUSIONS
  A TU approach is a feasible and efficient approach to selective amigdalohippocampectomy for surgical treatment of temporal lobe epilepsy. Postoperative DTI analysis suggests that a TU approach results in more injury to the temporal stem and its associated white matter fiber tracts than expected by previous anatomic studies; however, it was efficient in preserving OR.
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil. Electronic address: ghizonie@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ghizoni
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Roger Neves
authors.initials: RN
authors.lastname: Matias
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lieber
authors.affiliation: Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Brunno Machado
authors.initials: BM
authors.lastname: de Campos
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Clarissa Lin
authors.initials: CL
authors.lastname: Yasuda
authors.affiliation: Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: João Paulo Sant Ana Santos
authors.initials: JPSAS
authors.lastname: de Souza
authors.affiliation: Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Pamela Castro
authors.initials: PC
authors.lastname: Pereira
authors.affiliation: Department of Radiology, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Augusto Celso Scarparo
authors.initials: ACS
authors.lastname: Amato Filho
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Andrei Fernandes
authors.initials: AF
authors.lastname: Joaquim
authors.affiliation: Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Tátila Martins
authors.initials: TM
authors.lastname: Lopes
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Helder
authors.initials: H
authors.lastname: Tedeschi
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cendes
mesh_terms: D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D056324:Diffusion Tensor Imaging; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012640:Seizures / Q000601:surgery; D016896:Treatment Outcome
keywords: Fiber tracking; Hippocampus; Magnetic resonance; Temporal lobe epilepsy; Temporal stem; Uncus