Selective Amygdalohippocampectomy through Inferior Temporal Gyrus for Medial Temporal Lobe Epilepsy : Operative Approach and Results of 44 Cases

Selective amygdalohippocampectomy through the inferior temporal gyrus, transventricular approach, was performed in 44 cases with medically intractable medial temporal lobe epilepsy since 1990 at the National Utano Hospital. A follow-up evaluation(mean duration 57 months, ranged from 6 months to 131 momths)showed that 88.6%(39 cases)of patients were completely free of seizures(Engel class I), 9.1%(4 cases)were almost seizure free(class II)and 2.3%(1 case)had worthwhile improvement(class III). Major complications included transient psychological symptoms(14/44 ; 31.8%)and memory impairment(5/44 ; 11.4%). However, there was statistically significant increase in total and performance intelligent quotients. Our approach for selective amygdalohippocampectomy was presented and compared with other operative methods to show that our access to the hippocampus has little possibility to injure the anterior choroidal artery or optic radiation, and to open ambient cistern.