Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy

Numerous studies of the electrophysiology and neuropathology of temporal lo be epilepsy have demonstrated the mesial temporal structures to be the site of seizure origin in the majority of cases. This is the rationale for a tr anscortical selective approach, first introduced by Niemeyer, for removal o f the hippocampus and amygdala. Series from a number of centers have demons trated the efficacy of selective amygdalohippocampectomy compared to a more traditional resection. The technique described here and used at the Montre al Neurological Institute (MNI) utilizes a strictly endopial resection of t he hippocampal formation and amygdala in addition to computer image guidanc e to perform the procedure. Ninety-five percent of patients at the MNI who underwent selective amygdalohippocampectomy realized a cessation of seizure s, or greater than 90% reduction, with minimal risk of complications.