Transtemporal amygdalohippocampectomy: a novel minimally-invasive technique with optimal clinical results and low cost

Juan Antonio Castro Flores; Felipe Hada Sanders; Eberval Gadelha Figueiredo; Manoel Jacobsen Teixeira

doi:10.1590/0004-282X20170141

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(11): 801-808
DOI: 10.1590/0004-282X20170141

Article

Transtemporal amygdalohippocampectomy: a novel minimally-invasive technique with optimal clinical results and low cost

Amigdalo-hipocampectomia transtemporal: técnica minimamente invasiva com ótimos resultados clínicos e baixo custo

Juan Antonio Castro Flores

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, São Paulo SP, Brasil.

,

Felipe Hada Sanders

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, São Paulo SP, Brasil.

,

Eberval Gadelha Figueiredo

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, São Paulo SP, Brasil.

,

Manoel Jacobsen Teixeira

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, São Paulo SP, Brasil.

› Author Affiliations

Abstract

ABSTRACT

Mesial temporal sclerosis creates a focal epileptic syndrome that usually requires surgical resection of mesial temporal structures.

Objective: To describe a novel operative technique for treatment of temporal lobe epilepsy and its clinical results.

Methods: Prospective case-series at a single institution, performed by a single surgeon, from 2006 to 2012. A total of 120 patients were submitted to minimally-invasive keyhole transtemporal amygdalohippocampectomy.

Results: Of the patients, 55% were male, and 85% had a right-sided disease. The first 70 surgeries had a mean surgical time of 2.51 hours, and the last 50 surgeries had a mean surgical time of 1.62 hours. There was 3.3% morbidity, and 5% mild temporal muscle atrophy. There was no visual field impairment. On the Engel Outcome Scale at the two-year follow-up, 71% of the patients were Class I, 21% were Class II, and 6% were Class III.

Conclusion: This novel technique is feasible and reproducible, with optimal clinical results.

RESUMO

A esclerose mesial temporal é uma síndrome epiléptica focal que requer ablação de estruturas mesiais temporais.

Objetivo: Descrever e padronizar a técnica operatória e resultados clínicos.

Métodos: Série prospectiva de casos de uma única instituição, realizadas por um único cirurgião, de 2006 a 2012. 120 doentes foram submetidos a amigdalo-hipocampectomia transtemporal por acesso mínimo (keyhole).

Resultados: 55% eram do sexo masculino, 85% apresentavam doença do lado direito. As primeiras 70 cirurgias tiveram um tempo cirúrgico médio de 2,51 horas, e as últimas 50 cirurgias tiveram um tempo cirúrgico médio de 1,62 horas. Houve morbidade de 3,3%. 5% dos doentes apresentaram atrofia leve de músculo temporal. O controle das convulsões foi avaliado com a Escala de Engel no segundo ano de pós operatorio, 71% eram Classe I, 21% Classe II, 6% Classe III.

Conclusão: Esta nova técnica é viável, reprodutível e com resultados clínicos adequados.

Keywords:

anterior temporal lobectomy - epilepsy, temporal lobe - epilepsies, partial

Palavras-chave:

lobectomia temporal anterior - epilepsia do lobo temporal - epilepsias parciais

Full Text

References

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