Abstracts

The author describes a novel keyhole approach to selective amygdalohippocampectomy (SAH). The surgical technique has proven to be successful in the treatment of medically intractable mesial temporal lobe epilepsy (MTLE). Image guidance is required in the keyhole approach to orient the cranial opening, verify cortical landmarks for positioning the corticectomy, and assess the extent of hippocampal disconnection. The restricted surgical exposure has not limited the ability to perform SAH with favorable results on reducing the seizure tendency., All patients with one year or more follow-up after keyhole SAH at West Virginia University (WVU) were included in this report. Forty-eight surgeries for temporal lobe epilepsy have been performed since 2002 by the author with over one year follow-up. Ten had keyhole SAH performed and are the subjects reported here in.
Results of surgery in keyhole SAH subjects were contrasted with individuals undergoing SAH at WVU using standard craniotomy approach. All individuals since 2002 who underwent standard SAH surgery by the author for epilepsy and with over 1 year of postoperative follow-up were included in the evaluation., Ten subjects had keyhole approach for SAH performed. Seven (70%) had an excellent outcome from surgery becoming seizure free (Class I). One subject had over 90% seizure frequency reduction (Class III), and 2 had less than 90% reduction in seizure frequency (Class IV). Three subjects had no stereoelectroencephalography (SEEG) performed prior to keyhole SAH (all seizure free), and the remainder had SEEG performed for further confirmation of MTLE. There were no surgical complications encountered.
Twenty-One surgeries were performed for SAH using a standard craniotomy approach. 81% were seizure free after surgery. Excellent outcomes compared favorably between keyhole and non-keyhole approaches (p=0.54).
Hospital stay after surgery was determined for the subjects who underwent keyhole SAH at WVU and an age matched control of patients who had SAH performed via a non-keyhole (pterional craniotomy) approach at WVU. In keyhole SAH subjects the mean length of hospital stay was 3 days (range 2 - 4 days). Non-keyhole SAH patients stayed in the hospital a mean of 4 days (range 2 - 6 days) after surgery representing a trend to shorter hospital stays after keyhole SAH (p=0.11)., The keyhole approach to SAH is a strictly image guided procedure. The corticectomy is positioned at the upper bank of T2 anterior to the precentral suclus in the dominant hemisphere and in front of the central sulcus in the non-dominant hemisphere. These cortical landmarks can only be confirmed with image guidance. The results of surgery on the seizure tendency depend on an accurate diagnosis of MTLE, and compare favorably with non-keyhole SAH and corticoamygdalohippocampectomy for temporal lobe epilepsy. The keyhole SAH is an effective approach in patients undergoing surgery for MTLE.,