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09-07-2022 | Original Article - Neurosurgical Anatomy

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

Authors: Ruth Lau, Andreu Gabarros, Juan Martino, Alejandro Fernandez-Coello, Jose-Luis Sanmillan, Arnau Benet, Olivia Kola, Roberto Rodriguez-Rubio

Published in: Acta Neurochirurgica | Issue 11/2022

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.

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Title: Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study
Authors: Ruth Lau
Andreu Gabarros
Juan Martino
Alejandro Fernandez-Coello
Jose-Luis Sanmillan
Arnau Benet
Olivia Kola
Roberto Rodriguez-Rubio
Publication date: 09-07-2022
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2022
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-022-05295-7

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

Abstract

Purpose

Methods

Results

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