Endoscopic Transcortical Selective Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Takehiro Uda ◽  
Toshiyuki Kawashima ◽  
Masato Hattori ◽  
Yuichiro Kojima ◽  
Yuki Mito ◽  
...  
Keyword(s):  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Skin Incision ◽  
Cognitive Outcomes ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Surgical Video ◽  
Selective Amygdalohippocampectomy ◽  
Depth Electrodes ◽  
The Right

Abstract This surgical video shows a 19-yr-old woman with focal impaired awareness seizures. Seizure semiology showed no lateralizing signs. Ictal electroencephalography (EEG) failed to determine the seizure origin. Interictal EEG showed bilateral spike-and-waves at the temporal electrodes. Magnetic resonance imaging (MRI) showed suspected hippocampal sclerosis on the right side. To determine the side of the focus, depth electrodes were implanted in both hippocampi. Invasive video EEG identified the seizure origin on the right. The decision was made to perform selective amygdalohippocampectomy (SelAH) via the middle temporal gyrus (MTG). An endoscope was used to minimize the craniotomy and shorten the skin incision.  A 5-cm linear skin incision and 2.5-cm craniotomy were made. A thin tube was inserted to the inferior horn of the lateral ventricle (Inf-H) under neuronavigation to guide the route to the Inf-H. The endoscope was introduced. A 1.5-cm corticotomy was made at the MTG, and white matter was aspirated until opening the Inf-H. The hippocampus and parahippocampal gyrus were removed with the usual steps in microsurgical SelAH. The surgical time was 4 h 20 min. The patient was discharged without complications and has remained seizure free.  In addition to the preoperative objectives, using an endoscope widens the surgical view in the Inf-H compared with microsurgical procedures. Although seizure and cognitive outcomes are expected to be comparable to those from other methods of SelAH, invasiveness might be reduced. This appears to represent the first video report of endoscopic SelAH. The patient consented to the procedure and publication of her images and surgical video.

scholarly journals Hippocampal morphometry in sudden and unexpected death in epilepsy

Neurology ◽  
2019 ◽  
Vol 93 (8) ◽  
pp. e804-e814 ◽  
Author(s):  
Alyma Somani ◽  
Anita-Beatrix Zborovschi ◽  
Yan Liu ◽  
Smriti Patodia ◽  
Zuzanna Michalak ◽  
...  
Keyword(s):  
Granule Cell ◽  
Hippocampal Sclerosis ◽  
Qualitative Evaluation ◽  
Granule Cell Layer ◽  
Parahippocampal Gyrus ◽  
Unexpected Death ◽  
Cell Dispersion ◽  
Autonomic Networks ◽  
Left And Right ◽  
The Right

ObjectiveTo determine hippocampal morphometric measures, including granule cell dispersion and features of malrotation, as potential biomarkers for sudden unexpected death in epilepsy (SUDEP) from an archival postmortem series.MethodsIn a retrospective study of 187 archival postmortems from 3 groups, SUDEP (68; 14 with hippocampal sclerosis [HS]), non-SUDEP epilepsy controls (EP-C = 66; 25 with HS), and nonepilepsy controls (NEC = 53), Nissl/hematoxylin & eosin–stained sections from left and right hippocampus from 5 coronal levels were digitized. Image analysis was carried out for granule cell layer (GCL) thickness and measurements of hippocampal dimensions (HD) for shape (width [HD1], height [HD2]) and medial hippocampal positioning in relation to the parahippocampal gyrus (PHG) length (HD3). A qualitative evaluation of hippocampal malrotational (HMAL) features, dentate gyrus invaginations (DGI), and subicular/CA1 folds (SCF) was also made.ResultsGCL thickness was increased in HS more than those without (p < 0.001). In non-HS cases, increased GCL thickness was noted in EP-C compared to NEC (p < 0.05) but not between SUDEP and NEC. There was no difference in the frequency of DGI, SCF, measurements of hippocampal shape (HD1, HD2, or ratio), or medial positioning among SUDEP, EP-C, and NEC groups, when factoring in HS, coronal level, and age at death. Comparison between left and right sides within cases showed greater PHG lengths (HD3) on the right side in the SUDEP group only (p = 0.018).ConclusionsNo hippocampal morphometric features were identified in support of either excessive granule cell dispersion or features of HMAL as definitive biomarkers for SUDEP. Asymmetries in PHG measurements in SUDEP warrant further investigation as they may indicate abnormal central autonomic networks.

scholarly journals Neuropsychological outcomes of subtemporal selective amygdalohippocampectomy via a small craniotomy

2016 ◽  
Vol 125 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Peng-Fan Yang ◽  
Hui-Jian Zhang ◽  
Jia-Sheng Pei ◽  
Qiao Lin ◽  
Zhen Mei ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Brain Surgery ◽  
Mesial Temporal Sclerosis ◽  
Semantic Fluency ◽  
Verbal Comprehension ◽  
Subtemporal Approach ◽  
Selective Amygdalohippocampectomy

OBJECT The objectives of this study were to describe a novel minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with medically refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis, and to analyze the related outcomes. METHODS The authors analyzed data from all cases involving patients with unilateral MTLE due to hippocampal sclerosis who were treated with selective amygdalohippocampectomy via the posterior subtemporal approach through a relatively small craniotomy, without a neuronavigation system, at their institution during the period from September 2010 to September 2012. Data were obtained on baseline characteristics, preoperative evaluations of unilateral mesial temporal sclerosis, surgical complications, and Engel class seizure outcomes. All patients underwent memory testing, IQ testing, and language testing. RESULTS The mean duration of follow-up was 33.6 months (range 24–48 months). There were no deaths and no cases of significant postoperative morbidity. One patient had a mild complication. At 2-year follow-up, 19 patients were seizure free (Engel Class I outcome). Verbal memory scores obtained at 3 months and at 2 years after surgery were significantly lower than preoperative scores for patients who underwent surgery on the left side of the brain (p < 0.05). Pictorial memory scores were higher following surgery compared with before surgery regardless of whether patients underwent left- or right-sided brain surgery. There was also improvement in performance IQ and total IQ following surgery in both groups. For patients who underwent right-sided brain surgery, verbal comprehension and semantic fluency testing scores were significantly higher at both 3 months and 2 years after surgery than before surgery. For patients who underwent left-sided brain surgery, scores on all language tests were significantly lower at 3 months after surgery than before surgery. Verbal comprehension testing scores returned to the preoperative level at 2 years after surgery. CONCLUSIONS The posterior subtemporal approach through a relatively small craniotomy allows adequate exposure and safe resection of mesial temporal structures and effectively reduces medically intractable MTLE. It preserves IQ but may have a detrimental effect on verbal memory and language ability.

Subtemporal transparahippocampal amygdalohippocampectomy for surgical treatment of mesial temporal lobe epilepsy

1996 ◽  
Vol 1 (4) ◽  
pp. E2 ◽  
Author(s):  
T. S. Park ◽  
Blaise F. D. Bourgeois ◽  
Daniel L. Silbergeld ◽  
W. Edwin Dodson
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Pediatric Patients ◽  
Mesial Temporal Lobe Epilepsy ◽  
Fusiform Gyrus ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Language Mapping ◽  
Mesial Temporal Lobe ◽  
Sodium Amobarbital

Amygdalohippocampectomy (AH) is an accepted surgical option for treatment of medically refractory mesial temporal lobe epilepsy. Operative approaches to the amygdala and hippocampus that previously have been reported include: the sylvian fissure, the superior temporal sulcus, the middle temporal gyrus, and the fusiform gyrus. Regardless of the approach, AH permits not only extirpation of an epileptogenic focus in the amygdala and anterior hippocampus, but interruption of pathways of seizure spread via the entorhinal cortex and the parahippocampal gyrus. The authors report a modification of a surgical technique for AH via the parahippocampal gyrus, in which excision is limited to the anterior hippocampus, amygdala and parahippocampal gyrus while preserving the fusiform gyrus and the rest of the temporal lobe. Because transparahippocampal AH avoids injury to the fusiform gyrus and the lateral temporal lobe, it can be performed without intracarotid sodium amobarbital testing of language dominance and language mapping. Thus the operation would be particularly suitable for pediatric patients in whom intraoperative language mapping before resection is difficult.

Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis

2006 ◽  
Vol 104 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Eliseu Paglioli ◽  
André Palmini ◽  
Mirna Portuguez ◽  
Eduardo Paglioli ◽  
Ney Azambuja ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Seizure Control ◽  
Hippocampal Sclerosis ◽  
Surgical Techniques ◽  
Mesial Temporal Lobe Epilepsy ◽  
Outcome Data ◽  
Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy

Object The aim of this study was to compare seizure and memory outcome in patients with medically refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) treated using an anterior temporal lobectomy (ATL) or a selective amygdalohippocampectomy (SA). Methods Surgical outcome data were prospectively collected for 2 to 11 years in 161 consecutive patients with MTLE/HS. Eighty patients underwent an ATL and 81 an SA. Seizure control achieved with each technique was compared using the Engel classification scheme. Postoperative memory testing was performed in 86 patients (53%). At the last follow up, 72% of the patients who had undergone an ATL (mean follow up 6.7 years) and 71% of those who had undergone an SA (mean follow up 4.5 years) were seizure free (Engle Class IA). Estimated survival in patients in Engel Classes I, IA, and I and II combined did not differ between the two surgical techniques. Preoperatively, 58% of the patients had verbal memory scores one standard deviation (SD) below the normal mean. One third of the patients with preoperative scores in the normal range worsened after surgery, although this outcome was not related to the surgical technique. In contrast, one third of those whose preoperative scores were less than −1 SD experienced improvement after surgery. Nine (18%) of the 50 patients whose left side had been surgically treated improved their verbal memory scores by more than one SD. Seven (78%) of these nine underwent an SA (p = 0.05). Conclusions Both ATL and SA can lead to similar favorable seizure control in patients with MTLE/HS. Preliminary data suggest that postoperative verbal memory scores may improve in patients who undergo selective resection of a sclerotic hippocampus in the dominant temporal lobe.

scholarly journals Hippocampal morphometry in sudden and unexpected death in epilepsy (SUDEP)

2019 ◽  
Author(s):  
Alyma Somani ◽  
Anita-Beatrix Zborovschi ◽  
Yan Liu ◽  
Smriti Patodia ◽  
Zuzanna Michalak ◽  
...  
Keyword(s):  
Granule Cell ◽  
Hippocampal Sclerosis ◽  
Qualitative Evaluation ◽  
Granule Cell Layer ◽  
Parahippocampal Gyrus ◽  
Unexpected Death ◽  
Cell Dispersion ◽  
Significant Difference ◽  
Left And Right ◽  
The Right

ABSTRACTObjectiveTo determine hippocampal morphometric parameters, including granule cell dispersion and features of malrotation, as potential biomarkers for SUDEP from an archival post-mortem series.MethodsIn a retrospective study of 187 archival post-mortems from three groups, SUDEP (68; 14 with hippocampal sclerosis (HS)), non-SUDEP epilepsy controls (EP-C =66; 25 with HS) and non-epilepsy controls (NEC= 53), Nissl/H&E stained sections from left and right hippocampus from five coronal levels were digitised. Image analysis was carried out for granule cell layer (GCL) thickness and measurements of hippocampal dimensions (HD) for shape [width (HD1), height (HD2)] and medial hippocampal positioning in relation to the parahippocampal gyrus (PHG) length (HD3). A qualitative evaluation of hippocampal malrotational (HMAL) features, dentate gyrus invaginations (DGI) and subicular/CA1 folds (SCF) was also made.ResultsGCL thickness was increased in HS more than those without (p<0.001). In non-HS cases increased GCL thickness was noted in EP-C compared to NEC (p<0.05) but not between SUDEP and NEC. There was no significant difference in the frequency of DGI, SCF, measurements of hippocampal shape (HD1, HD2 or ratio) or medial positioning between SUDEP, EP-C and NEC groups, when factoring in HS, coronal level and age at death. Comparison between left and right sides within cases showed significantly greater PHG lengths (HD3) on the right side in the SUDEP group only (p=0.018)ConclusionsNo hippocampal morphometric features were identified in support of either excessive granule cell dispersion or features of HMAL as biomarkers for SUDEP. Asymmetries in PHG measurements in SUDEP warrant further investigation as they may indicate abnormal central autonomic networks.

scholarly journals Altered Spontaneous Brain Activity in Somatic Symptom Disorder: A Resting-state fMRI Study

2020 ◽  
Author(s):  
Yangyang Cui ◽  
Huai-Bin Liang ◽  
Qian Zhu ◽  
Zhaoxia Qin ◽  
Yue Hu ◽  
...  
Keyword(s):  
Resting State ◽  
Somatic Symptom ◽  
Inferior Frontal Gyrus ◽  
Anterior Cingulate ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Cingulate Gyrus ◽  
Medical Disorders ◽  
Medial Frontal Gyrus ◽  
The Right

Abstract Background: Somatic symptom disorders (SSDs) are common medical disorders characterized by various biological, social, and psychological pathogenic factors. Little is known about the neural correlations of SSD. Methods: In this study, we evaluated the dysfunction in 45 patients with SSD and in 43 controls by combining the regional homogeneity (ReHo) amplitudes of low-frequency fluctuation (ALFF) methods based on resting-state functional magnetic resonance imaging. Results: Compared to the controls, the patients with SSD exhibited significantly greater ReHo in the right cingulate gyrus and smaller ReHo in the right precuneus, left inferior and temporal gyrus extending to the left middle temporal gyrus and left parahippocampal gyrus, and right pons. The SSD patients showed higher ALFF values in the cingulate gyrus extending to the left medial frontal gyrus, right insula extending to the right inferior frontal gyrus, and left medial frontal gyrus extending to the left anterior cingulate cortex. Conclusions: These dysfunction areas seem to have a particular importance for the occurrence of SSD, which may result in dysfunction in self-relevant processes, emotional processing, multimodal integration, arousal, interoception, and body perception.

Inferior Temporal Sulcus as a Site of Corticotomy: Magnetic Resonance Imaging Analysis of Individual Sulcus Patterns

Neurosurgery ◽  
2001 ◽  
Vol 49 (6) ◽  
pp. 1394-1398 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Katsuya Ishido ◽  
Takehisa Araki ◽  
Kazufumi Kamikaseda
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hippocampal Sclerosis ◽  
Resonance Imaging ◽  
Temporal Lobes ◽  
Surface Anatomy ◽  
Selective Amygdalohippocampectomy ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

ABSTRACT OBJECTIVE Transcortical approaches to the inferior horn often result in quadrant hemianopsia attributable to the injury to the optic radiation. The inferior temporal sulcus (ITS) has received little attention as an entrance point for the transsulcal approach. We used the method of detecting the ITS with magnetic resonance imaging (MRI) scans and investigated the sulcus pattern of ITS, its incidence rate, and the availability of the ITS to the corticotomy for selective amygdalohippocampectomy. METHODS The sulcus patterns of the ITS of 100 temporal lobes in 50 healthy individuals were classified according to the number of interruptions by gyral bridges, and the localization of the ITS was characterized in relation to the outer surface by means of the surface anatomy scan of MRI. RESULTS Most of the ITS was interrupted by one to three gyral bridges (0 bridges, 8%; one bridge, 27%: two bridges, 37%; three bridges, 20%; more than four bridges or no apparent ITS, 8%). When the ITS was present, it was located 15 mm above the orbitotragus line at a point 20 mm anterior to the tragus. The number of gyral bridges was significantly larger in the left temporal lobes than in the right temporal lobes, regardless of the sex of the subject. CONCLUSION The ITS was clearly identified in 72% of the temporal lobes by the oblique sagittal view of MRI scans; thus, in such cases, the ITS was considered to be a candidate for an entrance point of a small temporal corticotomy. The preoperative observation of the ITS in relation to the orbitotragus line by means of MRI may improve the planning of the transsulcal approaches to deeply seated mesial temporal lesions, such as hippocampal sclerosis.

Subtemporal transparahippocampal amygdalohippocampectomy for surgical treatment of mesial temporal lobe epilepsy

1996 ◽  
Vol 85 (6) ◽  
pp. 1172-1176 ◽  
Author(s):  
T. S. Park ◽  
Blaise F. D. Bourgeois ◽  
Daniel L. Silbergeld ◽  
W. Edwin Dodson
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Fusiform Gyrus ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Language Mapping ◽  
Content Type ◽  
Mesial Temporal Lobe ◽  
Sodium Amobarbital

✓ Amygdalohippocampectomy (AH) is an accepted surgical option for treatment of medically refractory mesial temporal lobe epilepsy. Operative approaches to the amygdala and hippocampus that previously have been reported include: the sylvian fissure, the superior temporal sulcus, the middle temporal gyrus, and the fusiform gyrus. Regardless of the approach, AH permits not only extirpation of an epileptogenic focus in the amygdala and anterior hippocampus, but interruption of pathways of seizure spread via the entorhinal cortex and the parahippocampal gyrus. The authors report a modification of a surgical technique for AH via the parahippocampal gyrus, in which excision is limited to the anterior hippocampus, amygdala and parahippocampal gyrus while preserving the fusiform gyrus and the rest of the temporal lobe. Because transparahippocampal AH avoids injury to the fusiform gyrus and the lateral temporal lobe, it can be performed without intracarotid sodium amobarbital testing of language dominance and language mapping. Thus the operation would be particularly suitable for pediatric patients in whom intraoperative language mapping before resection is difficult.

scholarly journals Leukoaraiosis and Gray Matter Volume Alteration in Older Adults: The PROOF Study

2022 ◽  
Vol 15 ◽  
Author(s):  
Sébastien Celle ◽  
Claire Boutet ◽  
Cédric Annweiler ◽  
Romain Ceresetti ◽  
Vincent Pichot ◽  
...  
Keyword(s):  
Older Adults ◽  
Gray Matter ◽  
Gray Matter Volume ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Healthy Older Adults ◽  
Matter Volume ◽  
Fazekas Scale ◽  
The Right ◽  
The Relationship

Background and Purpose: Leukoaraiosis, also called white matter hyperintensities (WMH), is frequently encountered in the brain of older adults. During aging, gray matter structure is also highly affected. WMH or gray matter defects are commonly associated with a higher prevalence of mild cognitive impairment. However, little is known about the relationship between WMH and gray matter. Our aim was thus to explore the relationship between leukoaraiosis severity and gray matter volume in a cohort of healthy older adults.Methods: Leukoaraiosis was rated in participants from the PROOF cohort using the Fazekas scale. Voxel-based morphometry was performed on brain scans to examine the potential link between WMH and changes of local brain volume. A neuropsychological evaluation including attentional, executive, and memory tests was also performed to explore cognition.Results: Out of 315 75-year-old subjects, 228 had punctuate foci of leukoaraiosis and 62 had begun the confluence of foci. Leukoaraiosis was associated with a decrease of gray matter in the middle temporal gyrus, in the right medial frontal gyrus, and in the left parahippocampal gyrus. It was also associated with decreased performances in memory recall, executive functioning, and depression.Conclusion: In a population of healthy older adults, leukoaraiosis was associated with gray matter defects and reduced cognitive performance. Controlling vascular risk factors and detecting early cerebrovascular disease may prevent, at least in part, dementia onset and progression.

scholarly journals Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis

2003 ◽  
Vol 61 (3B) ◽  
pp. 707-711 ◽  
Author(s):  
Nelson Fortes Ferreira ◽  
Vanessa de Oliveira ◽  
Lázaro Amaral ◽  
Renato Mendonça ◽  
Sérgio Santos Lima
Keyword(s):  
High Resolution ◽  
Hippocampal Sclerosis ◽  
Parahippocampal Gyrus ◽  
Simultaneous Occurrence ◽  
Mesial Temporal Sclerosis ◽  
Anatomical Site ◽  
Volume Loss ◽  
Mr Images ◽  
Mamillary Body ◽  
The Right

PURPOSE: Analysis of the parahippocampal gyrus (PHG) involvement in 115 patients with hippocampal sclerosis (HS) by MR imaging. The simultaneous occurrence of ipsilateral fornix (F) and mamillary body (MB) volume loss was checked also. These findings were correlated with the side of hippocampal involvement, the sex, patient´s age, and the symptoms onset. METHOD: The MR images of 115 patients with HS were studied retrospectively. All the examinations were performed on 1.5 T units (SIGNA, GE, Milwaukee, WI) and included high resolution coronal T2-weighted images (3 mm thickness, 0.6 mm gap). RESULTS: The patient's age ranged between 3.5 and 80 years (mean 34.1); 62 (53.9%) were female and 53 (46.1%) were male. There were HS on the left side in 53 (46.0%), on the right side in 51 (44.3%), and bilateral in 11 (9.7%). In 43 (37.3%) cases there were ipsilateral PHG volume loss and signal hyper intensity on T2-weighted imaging. In 29 (25.2%) cases there were ipsilateral fornix volume loss and in 10 (34.5%) of this there were also ipsilateral MB changes. In abnormal PHG, 23 (53.4%) were on the left side, 17 (39.5%) were on the right side, and 3 (7.1%) were bilateral. There were fornix changes in 15 (34.8%) cases and MB volume loss in 5 (11.6%) cases. Pertinent clinical data were obtained in only 18 (41.8%) of the PHG lesion cases and 11 (61.1%) of these patients had epileptic attacks for more than 20 years before the examination. CONCLUSION: PHG involvement must be investigated in patients with HS and we suggest that the term mesial temporal sclerosis should be used only if there are also changes at this anatomical site.

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