Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy

被引:11
作者
Mandel, Mauricio [2 ,3 ]
Figueiredo, Eberval Gadelha [2 ]
Mandel, Suzana Abramovicz [2 ,3 ]
Tutihashi, Rafael [2 ,3 ,4 ]
Teixeira, Manoel Jacobsen [1 ,2 ]
机构
[1] Univ Sao Paulo, Hosp Clin, Med Sch, Dept Neurosurg, Sao Paulo, Brazil
[2] Hosp Sirio Libanes, Sao Paulo, Brazil
[3] Hosp Israelita Albert Einstein, Sao Paulo, Brazil
[4] Univ Sao Paulo, Hosp Clin, Med Sch, Dept Plast Surg, Sao Paulo, Brazil
关键词
Amygdala; Amygdalohippocampectomy; Epilepsy surgery; Hippocampus; Temporal lobe; TEMPORAL-LOBE EPILEPSY; LONG-TERM SEIZURE; TRANSCORTICAL SELECTIVE AMYGDALOHIPPOCAMPECTOMY; PROSPECTIVE CLINICAL-TRIAL; VISUAL-FIELD DEFECTS; ANTERIOR SKULL BASE; HIPPOCAMPAL SCLEROSIS; GYRUS APPROACH; SUBTEMPORAL AMYGDALOHIPPOCAMPECTOMY; NEUROPSYCHOLOGICAL OUTCOMES;
D O I
10.1227/NEU.0000000000001179
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes. OBJECTIVE: To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance. METHODS: A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe. RESULTS: The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars. CONCLUSION: The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.
引用
收藏
页码:2 / 13
页数:12
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