Ruth Lau1,2, Andreu Gabarros3, Juan Martino4, Alejandro Fernandez-Coello3, Jose-Luis Sanmillan3, Arnau Benet5,6,7, Olivia Kola5, Roberto Rodriguez-Rubio5,7. 1. Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA. ruth_lau_rodriguez@hotmail.com. 2. Deparment of Neurological Surgery, L´Hospital de Llobregat, Bellvitge University Hospital, 08907, Barcelona, Spain. ruth_lau_rodriguez@hotmail.com. 3. Deparment of Neurological Surgery, L´Hospital de Llobregat, Bellvitge University Hospital, 08907, Barcelona, Spain. 4. Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda. Valdecilla s/n, 39008, Santander, Cantabria, Spain. 5. Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, CA, USA. 6. Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, USA. 7. Department of Neurological Surgery, University of California, San Francisco, USA.
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.
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.
Authors: Baran Bozkurt; Ricardo da Silva Centeno; Feres Chaddad-Neto; Marcos Devanir Silva da Costa; Marcelo Augusto Acosta Goiri; Ali Karadag; Bekir Tugcu; Talat Cem Ovalioglu; Necmettin Tanriover; Serdar Kaya; Kaan Yagmurlu; Andrew Grande Journal: J Clin Neurosci Date: 2016-08-04 Impact factor: 1.961
Authors: Serhat Baydin; Abuzer Gungor; Necmettin Tanriover; Oguz Baran; Erik H Middlebrooks; Albert L Rhoton Journal: World Neurosurg Date: 2016-05-13 Impact factor: 2.104