Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study

Authors

Ruth Lau, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA. ruth_lau_rodriguez@hotmail.com.
Andreu Gabarros, Deparment of Neurological Surgery, L´Hospital de Llobregat, Bellvitge University Hospital, 08907, Barcelona, Spain.
Juan Martino, Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
Alejandro Fernandez-Coello, Deparment of Neurological Surgery, L´Hospital de Llobregat, Bellvitge University Hospital, 08907, Barcelona, Spain.
Jose-Luis Sanmillan, Deparment of Neurological Surgery, L´Hospital de Llobregat, Bellvitge University Hospital, 08907, Barcelona, Spain.
Arnau Benet, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA.
Olivia Kola, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA.
Roberto Rodriguez-Rubio, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA.

Document Type

Article

Abstract

PURPOSE: Selective amygdalohippocampectomy (SelAH) is one of the most common surgical treatments for mesial temporal sclerosis. Microsurgical approaches are associated with the risk of cognitive and visual deficits due to damage to the cortex and white matter (WM) pathways. Our objective is to test the feasibility of an endoscopic approach through the anterior middle temporal gyrus (aMTG) to perform a SelAH. METHODS: Virtual simulation with MRI scans of ten patients (20 hemispheres) was used to identify the endoscopic trajectory through the aMTG. A cadaveric study was performed on 22 specimens using a temporal craniotomy. The anterior part of the temporal horn was accessed using a tubular retractor through the aMTG after performing a 1.5 cm corticectomy at 1.5 cm posterior to the temporal pole. Then, an endoscope was introduced. SeIAH was performed in each specimen. The specimens underwent neuronavigation-assisted endoscopic SeIAH to confirm our surgical trajectory. WM dissection using Klingler's technique was performed on five specimens to assess WM integrity. RESULTS: This approach allowed the identification of collateral eminence, lateral ventricular sulcus, choroid plexus, inferior choroidal point, amygdala, hippocampus, and fimbria. SelAH was successfully performed on all specimens, and CT neuronavigation confirmed the planned trajectory. WM dissection confirmed the integrity of language pathways and optic radiations. CONCLUSIONS: Endoscopic SelAH through the aMTG can be successfully performed with a corticectomy of 15 mm, presenting a reduced risk of vascular injury and damage to WM pathways. This could potentially help to reduce cognitive and visual deficits associated with SelAH.

Medical Subject Headings

Humans; Feasibility Studies; Temporal Lobe (surgery); Epilepsy, Temporal Lobe (surgery); Amygdala (diagnostic imaging, surgery); Hippocampus (diagnostic imaging, surgery); Cadaver

Publication Date

11-1-2022

Publication Title

Acta neurochirurgica

E-ISSN

0942-0940

Volume

164

Issue

11

First Page

2841

Last Page

2849

PubMed ID

35809147

Digital Object Identifier (DOI)

10.1007/s00701-022-05295-7

Recommended Citation

Lau, Ruth; Gabarros, Andreu; Martino, Juan; Fernandez-Coello, Alejandro; Sanmillan, Jose-Luis; Benet, Arnau; Kola, Olivia; and Rodriguez-Rubio, Roberto, "Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study" (2022). Neurosurgery. 2114.
https://scholar.barrowneuro.org/neurosurgery/2114