Modifications to the subtemporal selective amygdalohippocampectomy using a minimal-access technique: seizure and neuropsychological outcomes

Technical note

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  • 1 Division of Neurological Surgery,
  • | 2 Department of Neuropsychology, and
  • | 3 Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Object

The authors introduce a minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with temporal lobe epilepsy and describe seizure and neuropsychological outcomes.

Methods

Between October 2003 and April 2007, 41 consecutive patients with intractable unilateral nonlesional temporal lobe epilepsy underwent image-guided subtemporal amygdalohippocampectomy. Baseline characteristics, preoperative evaluations, and seizure outcomes were assessed. Eighteen patients underwent pre- and postoperative neuropsychological testing for cognitive functioning, executive functioning, verbal and visual memory, and mood.

Results

Important aspects of the subtemporal approach include a low temporal keyhole craniotomy, use of image guidance, preservation of the tentorium, incision in the fusiform gyrus, and subpial, en bloc resection of the hippocampus. There were no deaths and no cases of significant postoperative morbidity. At 1 year, 29 of 36 patients (81%) were without seizures or auras. At 2 years, 17 of 23 (74%) patients were seizure- and aura-free. Detailed neuropsychological testing of language, memory, cognitive functioning, and executive functioning suggested that most patients exhibited either stability or improvement in their scores, regardless of language lateralization.

Conclusions

A minimal-access subtemporal approach for amygdalohippocampectomy is an effective treatment for temporal lobe epilepsy yielding encouraging preliminary seizure and neuropsychological outcomes.

Abbreviations used in this paper:

AHC = amygdalohippocampectomy; EEG = electroencephalographic.

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Contributor Notes

Address correspondence to: Kris A. Smith, M.D., c/o Neuroscience Publication, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

Please include this information when citing this paper: published online April 24, 2009; DOI: 10.3171/2008.10.17673.

  • 1

    Blumer D, Temporal lobe epilepsy and its psychiatric significance. Benson DF, & Blumer D: Psychiatric Aspects of Neurologic Disease New York, Grune & Stratton, 1975. 171198

    • Search Google Scholar
    • Export Citation
  • 2

    Blumer D, , Montouris G, & Hermann B: Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit. J Neuropsychiatry Clin Neurosci 7:445456, 1995

    • Search Google Scholar
    • Export Citation
  • 3

    Blumer D, , Wakhlu S, , Davies K, & Hermann B: Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications. Epilepsia 39:478486, 1998

    • Search Google Scholar
    • Export Citation
  • 4

    Burchiel C, & Christiano JA, Review of selective amygdalohippocampectomy techniques. Miller J, & Silbergeld D: Epilepsy Surgery: Principles and Controversies New York, Taylor & Francis Group, 2006. 451464

    • Search Google Scholar
    • Export Citation
  • 5

    Chelune GJ, , Naugle RI, , Hermann BP, , Barr WB, , Trenerry MR, & Loring DW, et al. : Does presurgical IQ predict seizure outcome after temporal lobectomy? Evidence from the Bozeman Epilepsy Consortium. Epilepsia 39:314318, 1998

    • Search Google Scholar
    • Export Citation
  • 6

    Engel J Jr: Surgical Treatment of the Epilepsies ed 2 New York, Raven Press, 1993

  • 7

    Engel J Jr, , Wiebe S, , French J, , Sperling M, , Williamson P, & Spencer D, et al. : Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology 60:538547, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Helmstaedter C, , Van RD, , Clusmann H, , Urbach H, , Elger CE, & Schramm J: Collateral brain damage, a potential source of cognitive impairment after selective surgery for control of mesial temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 75:323326, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Hermann BP, , Seidenberg M, , Haltiner A, & Wyler AR: Relationship of age at onset, chronologic age, and adequacy of preoperative performance to verbal memory change after anterior temporal lobectomy. Epilepsia 36:137145, 1995

    • Search Google Scholar
    • Export Citation
  • 10

    Hermann BP, , Seidenberg M, , Schoenfeld J, , Peterson J, , Leveroni C, & Wyler AR: Empirical techniques for determining the reliability, magnitude, and pattern of neuropsychological change after epilepsy surgery. Epilepsia 37:942950, 1996

    • Search Google Scholar
    • Export Citation
  • 11

    Hori T, , Tabuchi S, , Kurosaki M, , Kondo S, , Takenobu A, & Watanabe T: Subtemporal amygdalohippocampectomy for treating medically intractable temporal lobe epilepsy. Neurosurgery 33:5056, 1993

    • Search Google Scholar
    • Export Citation
  • 12

    Hori T, , Yamane F, , Ochiai T, , Kondo S, , Shimizu S, & Ishii K, et al. : Selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy: operative and neuropsychological outcomes. J Neurosurg 106:134141, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Langfitt JT, , Westerveld M, , Hamberger MJ, , Walczak TS, , Cicchetti DV, & Berg AT, et al. : Worsening of quality of life after epilepsy surgery: effect of seizures and memory decline. Neurology 68:19881994, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Niemeyer P, The transventricular amygdalo-hippocampectomy in the temporal lobe epilepsy. Baldwin M, & Bailey P: Temporal Lobe Epilepsy Springfield, IL, Charles C Thomas, 1958. 461482

    • Search Google Scholar
    • Export Citation
  • 15

    Niemeyer P, & Bello H: Amygdalo-hippocampectomy for temporal lobe epilepsy—microsurgical technique. Excerpta Medica 293:20, 1973. Abstract

    • Search Google Scholar
    • Export Citation
  • 16

    Olivier A, Temporal resections in the surgical treatment of epilepsy. Theodore WH: Surgical Treatment of Epilepsy Amsterdam, Elsevier, 1992. 175188

    • Search Google Scholar
    • Export Citation
  • 17

    Olivier A: Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy. Can J Neurol Sci 27:1 Suppl S68S76, 2000

  • 18

    Park TS, , Bourgeois BF, , Silbergeld DL, & Dodson WE: Subtemporal transparahippocampal amygdalohippocampectomy for surgical treatment of mesial temporal lobe epilepsy. Technical note. J Neurosurg 85:11721176, 1996

    • Search Google Scholar
    • Export Citation
  • 19

    Reid K, , Herbert A, & Baker GA: Epilepsy surgery: patient-perceived long-term costs and benefits. Epilepsy Behav 5:8187, 2004

  • 20

    Renowden SA, , Matkovic Z, , Adams CB, , Carpenter K, , Oxbury S, & Molyneux AJ, et al. : Selective amygdalohippocampectomy for hippocampal sclerosis: postoperative MR appearance. AJNR Am J Neuroradiol 16:18551861, 1995

    • Search Google Scholar
    • Export Citation
  • 21

    Robinson S, , Park TS, , Blackburn LB, , Bourgeois BF, , Arnold ST, & Dodson WE: Transparahippocampal selective amygdalohippocampectomy in children and adolescents: efficacy of the procedure and cognitive morbidity in patients. J Neurosurg 93:402409, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Shimizu H, , Suzuki I, & Ishijima B: Zygomatic approach for resection of mesial temporal epileptic focus. Neurosurgery 25:798801, 1989

  • 23

    Strauss E, & Wada J, Psychiatric and psychosocial changes associated with anterior temporal lobectomy. Devinsky O, & Theodore WH: Epilepsy and Behavior New York, Wiley-Liss, 1991. 135149

    • Search Google Scholar
    • Export Citation
  • 24

    Taylor DC, & Marsh SM, Implications of long-term follow-up studies in epilepsy. Penry JK: Epilepsy: The Eighth International Symposium New York, Raven Press, 1977. 2734

    • Search Google Scholar
    • Export Citation
  • 25

    Wieser HG, , Ortega M, , Friedman A, & Yonekawa Y: Long-term seizure outcomes following amygdalohippocampectomy. J Neurosurg 98:751763, 2003

    • Search Google Scholar
    • Export Citation
  • 26

    Wieser HG, & Yaşargil MG: Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol 17:445457, 1982

    • Search Google Scholar
    • Export Citation
  • 27

    Yaşargil MG, , Teddy PJ, & Roth P: Selective amygdalo-hippocampectomy. Operative anatomy and surgical technique. Adv Tech Stand Neurosurg 12:93123, 1985

    • Search Google Scholar
    • Export Citation
  • 28

    Yaşargil MG, , Ture U, & Yaşargil DC: Impact of temporal lobe surgery. J Neurosurg 101:725738, 2004

  • 29

    Yaşargil MG, , Wieser HG, , Valavanis A, , von Ammon K, & Roth P: Surgery and results of selective amygdala-hippocampectomy in one hundred patients with nonlesional limbic epilepsy. Neurosurg Clin N Am 4:243261, 1993

    • Search Google Scholar
    • Export Citation

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