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Anterior Temporal Lobectomy and Amygdalohippocampectomy

Surgical Correlation

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Anterior Temporal Lobectomy and Amygdalohippocampectomy. A, Coronal section through the right temporal lobe. The cortical incision (red arrows) and neocortical resection (vertical blue lines) usually spare the superior temporal gyrus. Resection of the amygdala, uncus, hippocampus, and parahippocampal gyrus is completed (horizontal blue lines) after the neocortical resection. B–F, Stepwise dissection in a cadaveric specimen showing the anterior temporal lobectomy and amygdalohippocampectomy. B, Temporal lobe and temporal pole from the sylvian fissure to the floor of the middle fossa have been exposed. C, Temporal horn has been opened to expose the choroid plexus and hippocampus. The inferior ventricular vein, which drains the optic radiations and sublenticular part of the internal capsule, courses in the roof of the temporal horn. D, Choroidal fissure has been opened and the structures in the ambient cistern have been exposed by separating the choroid plexus from the fimbria of the fornix. The choroid plexus remains attached to the thalamus in the roof of the temporal horn. E, Opening in the choroidal fissure has been extended forward through the amygdala at the level of the carotid-choroidal line (Wen’s line), which was used as the superior landmark to resect the amygdala and uncus. F, Anterior temporal lobectomy with resection of the amygdala, uncus, and hippocampus has been completed and the contents of the crural and ambient cisterns have been exposed. The P2A segment of the posterior cerebral artery courses in the crural cistern and the P2P courses in the ambient cistern. G, Lateral surgical view after a right anterior temporal lobectomy plus resection of amygdala, uncus, hippocampus, and parahippocampal gyrus in a 27-year-old woman harboring mesial temporal sclerosis (left) and resected temporal lobe included the head and anterior portion of the body of hippocampus and all of the amygdala (dotted lines), except the upper part adjacent to optic tract and globus pallidus (right). H, Postoperative magnetic resonance imaging showing the resection area. Seizure control was satisfactory at the 14-month follow-up (Engel Class I). (Images courtesy of AL Rhoton, Jr.)

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