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Selective Amygdalohippocampectomy

September 09, 2015


Although not frequently used, the transsylvian amygdalohippocampectomy is a reasonable route for resection of anterior medial temporal lobe tumors. This is a 43 year-old male with a single seizure. MRI evaluation revealed a relatively non-enhancing tumor along the right anterior aspect of the hippocampus in the uncus. Since the tumor is relatively anterior, a transsylvian approach was used. You can see the curvilinear incision primarily focused over the temporal lobe and the head turn, and the head is slightly extended. A right front temporal craniotomy was completed. Sylvian fissure was dissected widely. The MCA branches were mobilized and the inferior peri-insular sulcus was selected as the entry point into the temporal horn of the lateral ventricle. Here's the limen insula. The sphenoidal segment of the Sylvian fissure is also noted here. You can see that the M2 branches are mobilized out of the way. A corticotomy is completed. Within this pre-insular sulcus, neuro navigation is used. Here is the limen insula. Dissection within the temporal stem with a low exposure of the roof of the temporal horn. Here's entry into the temporal horn. Hippocampus and its lateral contour is evident. Here's the area of the amygdala. Subdural dissection of the amygdala is performed next. I continue this resection until the edge of the tentorium and the pial membranes over the basal cisterns and the third nerve are found. Here's the edge of the tentorium, the pial membranes. Here's the third nerve. So emictolectomy is relatively complete. Now I focus my attention more posteriorly. Here's the interior aspect of the choroid plexus. The anterior part of the hippocampus that is affected by the tumor is also removed. PCA perforators are carefully protected. Those perforators going to the hippocampus are obviously coagulated. Here's the final operative corridor. Post-operative MRI revealed gross total removal of the mass. Thank you.

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