Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy

Guive Sharifi; Mohammad Hallajnejad; Samaneh Sadat Dastgheib; Mahmoud Lotfinia; Omidvar Rezaei Mirghaed; Arsalan Medical Amin

doi:10.25259/SNI_199_2021

Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy

Surg Neurol Int. 2021 Nov 23:12:575. doi: 10.25259/SNI_199_2021. eCollection 2021.

Authors

Guive Sharifi¹, Mohammad Hallajnejad¹, Samaneh Sadat Dastgheib², Mahmoud Lotfinia³, Omidvar Rezaei Mirghaed¹, Arsalan Medical Amin¹

Affiliations

¹ Department of Neurosurgery, Skull Base Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran.
² Department for General Psychology and Cognitive Neuroscience, Friedrich Schiller University of Jena, Jena, Thuringia.
³ Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Saarland, Germany.

Abstract

Background: Selective amygdalohippocampectomy is one of the main approaches for treating medial temporal lobe epilepsy (TLE). We herewith describe seven cases of amygdala lesions treated with selective amygdalectomy with the hippocampus saving procedure. Furthermore, we explain the trans-middle temporal gyrus transventricular approach for selective amygdalectomy.

Methods: We studied patients with TLE who underwent selective amygdalectomy with hippocampal saving procedure between March 2012 and July 2018. We preferred the trans-middle temporal gyrus transventricular approach. We adopted pterional craniotomy with extensive exposure of the base and posterior of the temporal lobe. The posterior margin of resection in the intraventricular part of the amygdala was considered the inferior choroidal point. Medially anterior part of the uncus was resected until reaching the ambient cistern. We applied the transcortical transventricular approach for selective amygdalectomy in all patients.

Results: We present 11 cases having an amygdala lesion in our series, seven of whom underwent selective amygdalectomy with hippocampal sparing. Nine patients had neoplastic lesions, and in two of them, gliosis was evident. Total resection of the lesion was achieved in all cases based on postoperative magnetic resonance imaging. No unusual complication or surgically-related new neurological deficit occurred.

Conclusion: We consider the resection of the amygdala until the inferior choroidal point sufficient for the disconnection of its circuits, which results in more effective control of seizures and reduction of surgery time and complications.

Keywords: Amygdala; Amygdalectomy; Case series; Clinical outcome; Medial temporal lobe epilepsy.