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

Authors

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.

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

References
1 Kale R. Bringing epilepsy out of the shadows. BMJ. 1997;315(7099):2-3. https://doi.org/10.1136/bmj.315.7099.2
2 Margerison JH, Corsellis JA. Epilepsy and the temporal lobes. A clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular reference to the temporal lobes. Brain. 1966;89(3):499-530. https://doi.org/10.1093/brain/89.3.499
3 Hauser WA. The natural history of temporal lobe epilepsy. Epilepsy surgery. New York: Raven Press; 1991. p. 133-41.
4 Almeida Filho N, Pinho AR, Sampaio AP, Andrade Filho AS, Queiroz AC, Ribeiro BS et al. Epidemiologia social das epilepsias no Brasil: novas achegas sobre a epilepsia. Salvador: Centro Editorial e Didático de UFBA; 1980. p. 57-77.
5 Placencia M, Shorvon SD, Paredes V, Bimos C, Sander JW, Suarez J et al. Epileptic seizures in an Andean region of Ecuador. Incidence and prevalence and regional variation. Brain. 1992;115(3):771-82. https://doi.org/10.1093/brain/115.3J71
6 Clusmann H, Schramm J, Kral T, Helmstaedter C, Ostertun B, Fimmers R et al. Prognostic factors and outcome after different types of resection for temporal lobe epilepsy. J Neurosurg. 2002;9(5)7:1131-41. https://doi.org/10.3171/jns.2002.97.53131
7 Elliott RE, Bollo RJ, Berliner JL, Silverberg A, Carlson C, Geller EB et al. Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control. J Neurosurg. 2013;119(2):261-72. https://doi.org/10.3171/2013.4JNS121829
8 Vajkoczy P Krakow K, Stodieck S, Pohlmann-Eden B, Schmiedek P. Modified approach for the selective treatment of temporal lobe epilepsy: transsylvian-transcisternal mesial en bloc resection. J Neurosurg. 1998;88(5):855-62. https://doi.org/10.3171/jns.1998.88.5.0855
9 Wiebe S, Blume WT, Girvin JP Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311-8. https://doi.org/10.1056/NEJM200108023450501
10 Yasargil MG, Wieser HG, Valavanis A, Ammon K, Roth P Surgery and results of selective amygdala-hippocampectomy in one hundred patients with nonlesional limbic epilepsy. Neurosurg Clin N Am. 1993;4(2):243-61.
11 Olmo TS, Roelke CE, Farias MH. Lateral approach for amigdalohippocampectomy: morphometric data based on MRI and CT scans. Braz Neurosur. 2013;32:11-4.
12 Silva RC, Flores JAC, Aguiar GB, Cannoni LF, Duarte M, Barros JCEV. Anatomic study of the optical radiation and its relationship in the temporal lobe: definition of a secure approach for amigdalohipocampectomy in epilepsy surgery. Rev Chil Neurocirugía. 2014;40:8-11.
13 Duckworth EA, Vale FL. Trephine epilepsy surgery: the inferior temporal gyrus approach. Neurosurgery. 2008;63(1 Suppl 1):ONS156-60.
14 Clusmann H, Kral T, Gleissner U, Sassen R, Urbach H, Blumcke I et al. Analysis of different types of resection for pediatric patients with temporal lobe epilepsy. Neurosurgery. 2004;54(4):847-59. https://doi.org/10.1227/01.NEU.0000114141.37640.37
15 Hori T, Yamane F, Ochiai T, Kondo S, Shimizu S, Ishii K et al. Selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy: operative and neuropsychological outcomes. J Neurosurg. 2007;106(1):134-41. https://doi.org/10.3171/jns.2007.106.1J34
16 Niemeyer P. The transventricular amygdalohippocampectomy in temporal lobe epilepsy. In: Baldwin M, Bailey P, editors. Temporal lobe epilepsy. Springfield: Charles C. Thomas; 1958. p. 461-82.
17 Figueiredo EG, Deshmukh P, Nakaji P, Crusius MU, Teixeira MJ, Spetzler RF et al. Anterior selective amygdalohippocampectomy: technical description and microsurgical anatomy. Neurosurgery. 2010;66(3 Suppl Operative):45-53. https://doi.org/10.1227/01.NEU.0000350981.36623.8B
18 Hori T, Tabuchi S, Kurosaki M, Kondo S, Takenobu A, Watanabe T. Subtemporal amygdalohippocampectomy for treating medically intractable temporal lobe epilepsy. Neurosurgery. 1993;33(1):50-6. https://doi.org/10.1097/00006123-199307000-00008
19 Bender DB. Retinotopic organization of macaque pulvinar. J Neurophysiol. 1981;46(3):672-93.
20 Björk A, Kugelberg E. Visual field defects after temporal lobectomy. Acta Ophthalmol (Copenh). 1957;35(3):210-6. https://doi.org/10.1111/j.1755-3768.1957.tb05407.x
21 Egan RA, Shults WT, So N, Burchiel K, Kellogg JX, Salinsky M. Visual field deficits in conventional anterior temporal lobectomy versus amygdalohippocampectomy. Neurology. 2000;55(12):1818-22. https://doi.org/10.1212/WNL.55.12.1818
22 Meyer A. The connections of the occipital lobes and the present status of the cerebral visual affections. Trans Assoc Am Physicians. 1907;22:7-16.
23 Tanriverdi T, Olivier A, Poulin N, Andermann F, Dubeau F. Long-term seizure outcome after mesial temporal lobe epilepsy surgery: corticalamygdalohippocampectomy versus selective amygdalohippocampectomy. J Neurosurg. 2008;108(3):517-24. https://doi.org/10.3171/JNS/2008/108/3/0517
24 Olivier A. Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy. Can J Neurol Sci. 2000;27 Suppl 1:S68-76.