Abstracts

Selective amygdalohippocampectomy (SAH) is an effective treatment for intractable mesial temporal lobe epilepsy with an excellent opportunity for cure in appropriately selected patients.[1] At West Virginia University Medical Center, all individuals since August 2003 with mesial temporal seizure onset proven by chronic stereoelectroencephalography underwent a minimally invasive image guided key-hole craniotomy for SAH. This approach utilizes a small curvilinear temporal skin incision, a 2 cm size temporal craniotomy, image guided corticectomy over the upper bank of T2, and an image guided corridor to open the temporal horn and expose the mesial temporal structures. The SAH consists of subpial emptying of the entorhinal cortex and parahippocampus, en bloc removal of the hippocampal head and body, subpial emptying of the uncus, and removal of 4/5 of the amygdala. Six patients underwent an image guided key-hole craniotomy for SAH and were included in this study. Three are seizure free (50%). One has over 90% seizure reduction, one has over 60% seizure reduction, and 1 individual had 3 seizures in the early postoperative period only. There were no complications. Hospital stay averaged 3 days postoperatively. Image guided key-hole craniotomy for SAH is an effective treatment for mesial temporal lobe epilepsy. Despite a small scalp incision and keyhole cranial opening, excellent exposure of the mesial temporal structures is achieved. The approach requires the use of image guidance to confirm the location of T2 and the posterior extent of the T2 corticectomy in the dominant hemisphere. The goal of keyhole surgical approaches is to limit operative risk and patient discomfort while providing the best possible benefit. The image guided key-hole craniotomy for SAH achieves these goals.
[1] Olivier A. Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy. Can J Neurol Sci. 27 Suppl 1:S68-76, 2000