Anterior temporal lobectomy

Abstract

Background: Anterior temporal lobectomy is the most established neurosurgical procedure for temporal lobe epilepsy. Here we describe this technique.

Method: A temporal craniotomy is performed flush with the middle fossa and exposing the Sylvian fissure. The posterior extent of resection is determined as 4.5 cm in the dominant temporal lobe and 5.5 cm in the nondominant one. The first stage consists of removing the lateral neocortex and part of the fusiform gyrus, parallel to the Sylvian fissure, while keeping the temporal horn as the medial limit in the coronal plane. Then, the amygdala, uncus, fimbriae, hippocampus and collateral eminence are identified, transected and resected with the parahippocampal gyrus to complete the procedure.

Conclusion: Knowledge of the temporomesial anatomy, including neurovascular structures around the brainstem, is essential to keep this procedure safe and effective.

Keywords: Anterior temporal lobectomy; Epilepsy surgery; Technique.