Amygdalohippocampectomy

Amygdalohippocampectomy is a surgical procedure for the treatment of epilepsy. It consists of the removal of the hippocampus, which has a role in memory, spatial awareness, and navigation,cite journal | last =Ekstrom | first =AD | authorlink = | coauthors =Kahana M.J., Caplan J.B., Fields T.A., Isham E.A., Newman E.L., Fried I. | title =Cellular networks underlying human spatial navigation | journal =Nature | volume =425| issue =6954 | pages =184–188 | publisher = | date =2003 | url =http://memory.psych.upenn.edu/publications/files/EkstEtal03.pdf | doi = | pmid =12968182 | accessdate =2007-02-11] and the amygdalae, which have a role in the processing and memory of emotional reactions,cite journal |author=Olivier A |title=Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy |journal=Can J Neurol Sci. |volume=27 Suppl 1|pages=S68–76; discussion S92–6 |year=2000 |pmid=10830331] both structures forming part of the limbic system of the brain.

Amygdalohippocampectomy is used only when all other treatment options have failed to resolve the epilepsy. It is an effective treatment for most patients. However, possible adverse side effects include impaired memory and defects in visual perception.

Procedure

The procedure is indicated when the focal point of the seizures can be anatomically localized to the hippocampus and amygdala. Normally, to be considered for this procedure, one must have failed all first-line treatments. [cite journal |author=Smith KA, Detwiler PW, Porter RW |title=Surgical Treatment of Intractable Epilepsy |journal=BNI Quarterly |year=1999 |volume=15 |issue=1 |url=http://www.emergemd.com/bniq/article.asp?article_ref_id=15-1-4 |format=dead link|date=June 2008 – ^{[http://scholar.google.co.uk/scholar?hl=en&lr=&q=author%3A+intitle%3ASurgical+Treatment+of+Intractable+Epilepsy&as_publication=BNI+Quarterly&as_ylo=1999&as_yhi=1999&btnG=Search Scholar search]} ] The selective amygdalohippocampectomy will remove only the offending portions of the hippocampus and amygdala. [cite journal |author=Bate H, Eldridge P, Varma T, Wieshmann UC |title=The seizure outcome after amygdalohippocampectomy and temporal lobectomy |journal=Eur. J. Neurol. |volume=14 |issue=1 |pages=90–4 |year=2007 |month = January |pmid=17222120 |doi=10.1111/j.1468-1331.2006.01565.x] When data from studies of the electrophysiology and neuropathy "vis-à-vis" temporal lobe epilepsy determines this area to be the origin of seizure activity, the removal of the hippocampus and amygdala is usually indicated. Computer imaging is sometimes used to guide this procedure. Patients continue normal activity after approximately six to eight weeks.

Statistics and side effects

Of 376 patients who had the amygdalohippocampectomy procedure performed, compared to other types of temporal lobe resections, two thirds of this population were reported free of disabling seizures. [cite journal |author=Engel J, Wiebe S, French J, "et al" |title=Practice parameter: Temporal lobe and localized neocortical resections for epilepsy |journal=Neurology |volume=60 |issue=4 |pages=538–47 |year=2003 |url=http://www.neurology.org/cgi/content/full/60/4/538 |pmid=12601090] Some patients report defects in visual perception [cite conference |author = Dr Novak Klaus |coauthors = K Kircher, A Reitner, C Baumgartner, T Czech |title = Visual Field Defects After Selective Transsylvian Amygdalohippocampectomy |booktitle = 14th Meeting of the World Society for Stereotactic and Functional Neurosurgery |year = 2005 |url = https://www.ifess.org/INS_WSSFN_2005/WSSFN/ABSTRACT/418.pdf] and impaired memory function. [cite journal |author=Gleissner U, Helmstaedter C, Schramm J, Elger CE |title=Memory outcome after selective amygdalohippocampectomy: a study in 140 patients with temporal lobe epilepsy |journal=Epilepsia |volume=43 |issue=1 |pages=87–95 |year=2002 |pmid=11879392 |doi=10.1046/j.1528-1157.2002.24101.x]

References