Selective Amygdalohippocampectomy

Mesial temporal lobe epilepsy is a common condition that is frequently drug resistant. Anterior temporal lobectomy has been shown to be effective in controlling seizures but entails resecting anterior and lateral temporal lobe regions that are not necessarily included in the epileptogenic zone. Selective amygdalohippocampectomy spares uninvolved structures while providing the same benefit as anterior temporal lobectomy. This article describes the 3 most common surgical approaches for performing selective amygdalohippocampectomy and discusses their relative merits and risks.

Key points

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Selective amygdalohippocampectomy effectively reduces seizure severity and frequency in patients with mesial temporal epilepsy.
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Selective procedures seem to be as effective as anterior temporal lobectomy in patients whose disease is limited to the mesial temporal structures.
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Although the evidence is inconclusive, it suggests that selective amygdalohippocampectomy may preserve neurocognitive function better than anterior temporal lobectomy.
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Multiple approaches are available to access the mesial temporal structures.
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There is no definitive evidence for the superiority of a particular approach in terms of seizure control or neurocognitive outcome.