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Anterior Selective Amygdalohippocampectomy: Technical Description and Microsurgical Anatomy

Figueiredo, Eberval Gadelha MD, PhD; Deshmukh, Pushpa PhD; Nakaji, Peter MD; Crusius, Marcelo U. MD; Teixeira, Manoel J. MD, PhD; Spetzler, Robert F. MD; Preul, Mark C. MD

doi: 10.1227/01.NEU.0000350981.36623.8B
Surgical Anatomy: Surgical Anatomy and Technique

OBJECTIVE: We introduce a technique for performing a selective amygdalohippocampectomy (AH) through a minisupraorbital approach.

METHODS: A minisupraorbital craniotomy and an anterior selective AH were performed in 8 cadaver heads (16 sides). The anatomic specimens were analyzed, and the extent of resection of the hippocampus and amygdala was evaluated. Surgically relevant measurements were performed using anatomic specimens. An image-guided system was used to document the extent of the anterior AH. Laboratory data were used to support the clinical application of the technique.

RESULTS: The anterior route allowed removal of the amygdala and hippocampus, as confirmed by anatomic assessment. The image-guided system and anatomic evaluation confirmed that the amygdala and hippocampus can be accessed and removed through this route. The mean distance between the anterior aspect of the uncus and the tip of the temporal horn was 17.0 ± 4.6 mm; the mean distance from the head of the hippocampus to the posterior border of the cerebral peduncles was 26.0 ± 3.2 mm. Clinical application resulted in satisfactory removal of the amygdala and hippocampus.

CONCLUSION: The anterior route for selective AH is a logical and straightforward approach to the mesial temporal lobe. Compared with other variations, it is less invasive and destructive, especially in terms of the fibers of the optic pathway, temporal stem, and lateral temporal neocortex.

On the Cover While technology pushes operative techniques forward, a similar impact can be observed in the world of graphic design. This cover was not painstakingly rendered after weeks of trials and tribulations, but instead was automated by a commercially-available Adobe Photoshop action. Developed by PanoFX, the Panos Cubes action allows a graphic designer to select images and render them onto the face of a 3-D cube. The cube figures were selected from both this issue and the December issue of Operative Neurosurgery. The process takes seconds.

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona (Figueiredo) (Deshmukh) (Nakaji) (Spetzler) (Preul)

Institute of Neurology and Neurosurgery, Passo Fundo, Brazil (Crusius)

Division of Neurological Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil (Teixeira)

Reprint requests: Mark C. Preul, MD, c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013. Email:

Received, December 16, 2008.

Accepted, April 15, 2009.

Copyright © by the Congress of Neurological Surgeons