Amygdalohippocampotomy: surgical technique and clinical results

Clinical article

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  • 1 Department of Neurosurgery;
  • | 2 Department of Neurology, Neuropathology Laboratory;
  • | 3 Department of Neurology, EEG Laboratory; and
  • | 4 Department of Neurological Imaging, Unit of Epilepsy Surgery, Department of Neurosciences, University Hospital Santa Maria, Lisbon, Portugal
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Object

The removal of mesial temporal structures, namely amygdalohippocampectomy, is the most efficient surgical procedure for the treatment of epilepsy. However, disconnection of the epileptogenic zones, as in temporal lobotomy or, for different purposes, hemispherotomy, have shown equivalent results with less morbidity. Thus, authors of the present study began performing selective amygdalohippocampotomy in cases of refractory mesial temporal lobe epilepsy (TLE) to treat mesial temporal lobe sclerosis (MTLS).

Method

The authors conducted a retrospective analysis of all cases of amygdalohippocampotomy collected in a database between November 2007 and March 2011.

Results

Since 2007, 21 patients (14 males and 7 females), ages 20–58 years (mean 41 years), all with TLE due to MTLS, were treated with selective ablation of the lateral amygdala plus perihippocampal disconnection (anterior one-half to two-thirds in dominant hemisphere), the left side in 11 cases and the right in 10. In 20 patients the follow-up was 2 or more years (range 24–44 months, average 32 months). Clinical outcome for epilepsy 2 years after surgery (20 patients) was good/very good in 19 patients (95%) with an Engel Class I (15 patients [75%]) or II outcome (4 patients [20%]) and bad in 1 patient (5%) with an Engel Class IV outcome (extratemporal focus and later reoperation).

Surgical morbidity included hemiparesis (capsular hypertensive hemorrhage 24 hours after surgery, 1 patient), verbal memory worsening (2 patients), and quadrantanopia (permanent in 2 patients, transient in 1). Late psychiatric depression developed in 3 cases. Operative time was reduced by about 30 minutes (15%) on average with this technique.

Conclusions

Amygdalohippocampotomy is as effective as amygdalohippocampectomy to treat MTLS and is a potentially safer, time-saving procedure.

Abbreviations used in this paper:

AHC = amygdalohippocampectomy; AHCo = amygdalohippocampotomy; EEG = electroencephalography; MTLS = mesial temporal lobe sclerosis; TLE = temporal lobe epilepsy.

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  • 1

    Behrens E, , Schramm J, , Zentner J, & König R: Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41:110, 1997

    • Search Google Scholar
    • Export Citation
  • 2

    Bernasconi N, , Bernasconi A, , Caramanos Z, , Antel SB, , Andermann F, & Arnold DL: Mesial temporal damage in temporal lobe epilepsy: a volumetric MRI study of the hippocampus, amygdala and parahippocampal region. Brain 126:462469, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Bogen JE, & Vogel PJ: Treatment of generalized seizures by cerebral commissurotomy. Surg Forum 14:431433, 1963

  • 4

    Campero A, , Tróccoli G, , Martins C, , Fernandez-Miranda JC, , Yasuda A, & Rhoton AL Jr: Microsurgical approaches to the medial temporal region: an anatomical study. Neurosurgery 59:4 Suppl 2 ONS279ONS308, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Chabardès S, , Minotti L, , Hamelin S, , Hoffmann D, , Seigneuret E, & Carron R, et al.: [Temporal disconnection as an alternative treatment for intractable temporal lobe epilepsy: techniques, complications and results.]. Neurochirurgie 54:297302, 2008. (Fr)

    • Search Google Scholar
    • Export Citation
  • 6

    Choi C, , Rubino PA, , Fernandez-Miranda JC, , Abe H, & Rhoton AL Jr: Meyer's loop and the optic radiations in the transsylvian approach to the mediobasal temporal lobe. Neurosurgery 59:4 Suppl 2 ONS228ONS236, 2006

    • Search Google Scholar
    • Export Citation
  • 7

    Cohen-Gadol AA, , Wilhelmi BG, , Collignon F, , White JB, , Britton JW, & Cambier DM, et al.: Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. J Neurosurg 104:513524, 2006

    • Search Google Scholar
    • Export Citation
  • 8

    de Oliveira JG, , Párraga RG, , Chaddad-Neto F, , Ribas GC, & de Oliveira EPL: Supracerebellar transtentorial approach—resection of the tentorium instead of an opening—to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications. Clinical article. J Neurosurg 116:764772, 2012

    • Search Google Scholar
    • Export Citation
  • 9

    Delalande O, , Pinard JM, , Basdevant C, , Gauthe M, , Plouin P, & Dulac O: Hemispherotomy: a new procedure for central disconnection. Epilepsia 33:3 Suppl 99100, 1992

    • Search Google Scholar
    • Export Citation
  • 10

    Duvernoy HM: The Human Hippocampus: Functional Anatomy, Vascularization and Serial Sections with MRI ed 3 Berlin, Springer-Verlag, 2005

  • 11

    Erdem A, , Yaşargil G, & Roth P: Microsurgical anatomy of the hippocampal arteries. J Neurosurg 79:256265, 1993

  • 12

    Gonçalves-Ferreira A, , Miguéns J, , Farias JP, , Levy-Melancia J, & Andrade M: Selective amygdalohippocampectomy: which route is the best?. Stereotact Funct Neurosurg 63:182191, 1994

    • Search Google Scholar
    • Export Citation
  • 13

    Hermann BP, , Seidenberg M, , Dohan FC Jr, , Wyler AR, , Haltiner A, & Bobholz J, et al.: Reports by patients and their families of memory change after left anterior temporal lobectomy: relationship to degree of hippocampal sclerosis. Neurosurgery 36:3945, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Hori T, , Tabuchi S, , Kurosaki M, , Kondo S, , Takenobu A, & Watanabe T: Subtemporal amygdalohippocampectomy for treating medically intractable temporal lobe epilepsy. Neurosurgery 33:5057, 1993

    • Search Google Scholar
    • Export Citation
  • 15

    Jehi L, Mesial temporal lobectomy: post-surgical seizure frequency. Lüders HO: Textbook of Epilepsy Surgery London, Informa UK, 2008. 12231235

    • Search Google Scholar
    • Export Citation
  • 16

    Kanner AM, & Balabanov AJ, Psychiatric outcome of epilepsy surgery. Lüders HO: Textbook of Epilepsy Surgery London, Informa UK, 2008. 12541262

    • Search Google Scholar
    • Export Citation
  • 17

    Lopes da Silva FH, , Witter MP, , Boeijinga PH, & Lohman AHM: Anatomic organization and physiology of the limbic cortex. Physiol Rev 70:453511, 1990

    • Search Google Scholar
    • Export Citation
  • 18

    Lüders HO, Mesial temporal sclerosis. Lüders HO: Textbook of Epilepsy Surgery London, Informa UK, 2008. 249251

  • 19

    Luessenhop AJ: Interhemispheric commissurotomy as an alternative to hemispherectomy for control of intractable seizures. Am Surg 36:265268, 1970

    • Search Google Scholar
    • Export Citation
  • 20

    Mohamed AR, , Freeman JL, , Maixner W, , Bailey CA, , Wrennall JA, & Harvey AS: Temporoparietooccipital disconnection in children with intractable epilepsy. Clinical article. J Neurosurg Pediatr 7:660670, 2011

    • Search Google Scholar
    • Export Citation
  • 21

    Nayel MH, , Awad IA, & Luders HL: Extent of mesiobasal resection determines outcome after temporal lobectomy for intractable complex partial seizures. Neurosurgery 29:5561, 1991

    • Search Google Scholar
    • Export Citation
  • 22

    Naylor AS, , Rogvi-Hansen , , Kessing L, & Kruse-Larsen C: Psychiatric morbidity after surgery for epilepsy: short-term follow up of patients undergoing amygdalohippocampectomy. J Neurol Neurosurg Psychiatry 57:13751381, 1994

    • Search Google Scholar
    • Export Citation
  • 23

    Ng WH, & Valiante T: Lateral temporal lobectomy with hippocampal disconnection as an alternative surgical technique for temporal lobe epilepsy. J Clin Neurosci 17:634635, 2010

    • Search Google Scholar
    • Export Citation
  • 24

    Niemeyer P, The transventricular amygdalohippocampectomy in temporal lobe epilepsy. Baldwin M, & Bailey P: Temporal Lobe Epilepsy: A Colloquium Sponsored by the National Institute of Neurological Diseases and Blindness, National Institute of Health, Bethesda, Maryland, in Cooperation with the International League Against Epilepsy Springfield, IL, Charles C Thomas, 1958. 461482

    • Search Google Scholar
    • Export Citation
  • 25

    Ojemann GA, & Silbergeld DL: Approaches to epilepsy surgery. Neurosurg Clin N Am 4:183191, 1993

  • 26

    Olivier A, Commentary: cortical resections. Engel J Jr: Surgical Treatment of the Epilepsies New York, Raven Press, 405416, 1987

  • 27

    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
  • 28

    Penfield W, & Jasper H: Epilepsy and The Functional Anatomy of the Human Brain London, J & A Churchill, 1954

  • 29

    Peuskens D, , van Loon J, , Van Calenbergh F, , van den Bergh R, , Goffin J, & Plets C: Anatomy of the anterior temporal lobe and the frontotemporal region demonstrated by fiber dissection. Neurosurgery 55:11741184, 2004

    • Search Google Scholar
    • Export Citation
  • 30

    Pimentel J, , Bentes C, , Campos A, & Ferreira AG: Long-term and late seizure outcome after surgery for temporal lobe epilepsy. Epileptic Disord 12:5458, 2010

    • Search Google Scholar
    • Export Citation
  • 31

    Régis J, , Bartolomei F, & Chauvel P, Radiosurgery. Baltuch GH, & Villemure JG: Operative Techniques in Epilepsy Surgery New York, Thieme, 2009. 187196

    • Search Google Scholar
    • Export Citation
  • 32

    Renella RR: Microsurgery of the Temporo-Medial Region Vienna, Springer-Verlag, 1990

  • 33

    Rougier A, , Saint-Hilaire J, , Bouvier G, , Loiseau P, , Baulac M, & Bouthillier A, et al.: [Research and surgical treatment of the epilepsies.]. Neurochirurgie 38:Suppl 1 1112, 1992. (Fr)

    • Search Google Scholar
    • Export Citation
  • 34

    Rubino PA, , Rhoton AL Jr, , Tong X, & Oliveira Ed: Three-dimensional relationships of the optic radiation. Neurosurgery 57:4 Suppl 219227, 2005

    • Search Google Scholar
    • Export Citation
  • 35

    Rydenhag B, & Silander HC: Complications of epilepsy surgery after 654 procedures in Sweden, September 1990–1995: a multicenter study based on the Swedish National Epilepsy Surgery Register. Neurosurgery 49:5157, 2001

    • Search Google Scholar
    • Export Citation
  • 36

    Sasaki-Adams D, & Hadar EJ, Temporal lobe epilepsy surgery: surgical complications. Lüders HO: Textbook of Epilepsy Surgery London, Informa UK, 2008. 12881299

    • Search Google Scholar
    • Export Citation
  • 37

    Schramm J: Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 49:12961307, 2008

  • 38

    Schramm J, , Behrens E, & Entzian W: Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 36:509516, 1995

    • Search Google Scholar
    • Export Citation
  • 39

    Schramm J, , Lehmann TN, , Zentner J, , Mueller CA, , Scorzin J, & Fimmers R, et al.: Randomized controlled trial of 2.5-cm versus 3.5-cm mesial temporal resection in temporal lobe epilepsy—Part 1: intent-to-treat analysis. Acta Neurochir (Wien) 153:209219, 2011

    • Search Google Scholar
    • Export Citation
  • 40

    Sincoff EH, , Tan Y, & Abdulrauf SI: White matter fiber dissection of the optic radiations of the temporal lobe and implications for surgical approaches to the temporal horn. J Neurosurg 101:739746, 2004

    • Search Google Scholar
    • Export Citation
  • 41

    Sindou M, & Guenot M: Surgical anatomy of the temporal lobe for epilepsy surgery. Adv Tech Stand Neurosurg 28:315343, 2003

  • 42

    Türe U, , Harput MV, , Kaya AH, , Baimedi P, , Firat Z, & Türe H, et al.: The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study. Laboratory investigation. J Neurosurg 116:773791, 2012

    • Search Google Scholar
    • Export Citation
  • 43

    Ulm AJ III, , Tanriover N, , Rhoton AL Jr, & Roper SN, Surgical anatomy of the temporal lobe. Starr PA, , Barbaro NM, & Larson PS: Functional Neurosurgery New York, Thieme, 2009. 1628

    • Search Google Scholar
    • Export Citation
  • 44

    Van Wagenen WP, & Herren RY: Surgical division of commissural pathways in the corpus callosum. Arch Neurol Psychiatry 44:740759, 1940

  • 45

    Velasco M, , Velasco F, , Velasco AL, , Boleaga B, , Jimenez F, & Brito F, et al.: Subacute electrical stimulation of the hippocampus blocks intractable temporal lobe seizures and paroxysmal EEG activities. Epilepsia 41:158169, 2000

    • Search Google Scholar
    • Export Citation
  • 46

    Villemure JG, & Mascott CR: Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 37:975981, 1995

  • 47

    Vonck K, , Boon P, , Achten E, , De Reuck J, & Caemaert J: Longterm amygdalohippocampal stimulation for refractory temporal lobe epilepsy. Ann Neurol 52:556565, 2002

    • Search Google Scholar
    • Export Citation
  • 48

    Wen HT, , Rhoton AL Jr, , de Oliveira E, , Cardoso AC, , Tedeschi H, & Baccanelli M, et al.: Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 45:549592, 1999

    • Search Google Scholar
    • Export Citation
  • 49

    Wiebe S, , Blume WT, , Girvin JP, & Eliasziw M: A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:311318, 2001

    • Search Google Scholar
    • Export Citation
  • 50

    Wieser HG: ILAE Commission Report. Mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 45:695714, 2004

  • 51

    Wieser HG, & Yaşargil MG: Selective amygdalohippocampectomy as a surgical treatment of mediobasal limbic epilepsy. Surg Neurol 17:445457, 1984

    • Search Google Scholar
    • Export Citation
  • 52

    Wilson DH, , Culver C, , Waddington M, & Gazzaniga M: Disconnection of the cerebral hemispheres. An alternative to hemispherectomy for the control of intractable seizures. Neurology 25:11491153, 1975

    • Search Google Scholar
    • Export Citation
  • 53

    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
  • 54

    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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