Selective Amygdalohippocampectomy in the Treatment of Mesial Temporal Lobe Epilepsy: Technical Pitfalls of Transsylvian Approach

Background: Epilepsy is a chronic neurologic disorder that affects 2% of the world’s population and the mesial temporal lobe epilepsy is the most prevalent medically refractory epilepsy in adolescents and adults, whose pathologic hallmark classic is hippocampal sclerosis. Although the surgical treatment in clinically refractory epilepsy is the best indication, the choose between the techniques still as a significant question in the literature.

Objective: The authors describe the surgical procedure of the selective amygdalohippocampectomy (SAH) beginning by the opening of the sylvian fissure in order to verify all landmarkers to accomplish the technique introducing a new concepts and comparison between the techniques.

Methods: It was performed bibliographical consultation, using the databases MEDLINE, LILACS, SciELO, BIREME, Scopus, PubMED, utilizing language as selection criteria, choosing preferably recent articles in Portuguese, Spanish or English.

Results: The authors advocate the method, and showed that the best point for opening the temporal surface, in insular sulci beside the arterial bifurcation M1–M2 is about 1–2 cm. There are few systematic reviews and meta-analyses comparing SAH and anterior temporal lobectomy (ATL) results. The transsylvian approach provides an adequate operative field to remove the structures of epileptic focus minimizing damage to the surrounding vascular, cerebral peduncle, basal veins, optic nerve and neocortex when compared to Niemeyer’s technique and ATL. Furthermore, this technique can be possible careful dissection associated to a minimal retraction when compared to subtemporal (Hori’s description), transparahipocampal (Park’s description) and transsulcal of middle temporal sulci (Olivier’s description). However, the ATL (Spencer’s description) showed higher rates of seizure-free when compared all the techniques.

Conclusion: SAH by transsylvian acess showed an effective treatment for drug-resistant mesial temporal sclerosis associated to a lower rates of functional complication in the outcome. Although the authors advocate the need of more significant studies comparing the outcome of these SAH descriptions and ATL.