Abstract

Background

Selective amygdalohippocampectomy (AH) is a surgical option for patients with medically intractable seizures from mesial temporal lobe pathology. The transcranial route is considered the best method to achieve this goal. However, the standard approach through the neocortex is still invasive. The risks can be minimized if the mesial temporal lobe is resected while preserving the lateral temporal lobe and the Meyer’s loop. This study explores the feasibility of selective AH by endoscopic endonasal approach (EEA) in cadaveric specimens.

Methods

The endoscopic anatomy of the mesial temporal lobe and the feasibility of a successful selective AH were studied in six hemispheres from three injected human cadavers. Quantitative analyses on the extent of resection and angles of exposure were performed based on CT and MRI studies of pre- and post-selective AH and measurements taken during dissections.

Results

The EEA V1-V2 corridor provided a direct and logical line of access to the mesial temporal lobe, following its natural trajectory with no brain retraction and minimal exposure of the pterygopalatine fossa. The components of the mesial temporal lobe were resected just as selectively and easily as the transcranial route, but without compromising the structures of the lateral temporal lobe or the Meyer’s loop.

Conclusions

The EEA V1-V2 corridor demonstrated its selective resectability and accessibility of the mesial temporal lobe in cadaveric specimens. The clinical value of this approach should be explored responsibly by a surgeon with both competent microsurgical skills and experiences in EEA.

中文翻译：

---

内侧颞叶的内窥镜鼻内入路：选择性杏仁核海马切除术的解剖学研究和临床考虑。

摘要

背景

选择性杏仁核海马切除术 (AH) 是内侧颞叶病理学顽固性癫痫患者的一种手术选择。经颅途径被认为是实现这一目标的最佳方法。然而，通过新皮质的标准方法仍然是侵入性的。如果在保留外侧颞叶和 Meyer 环的同时切除内侧颞叶，可以将风险降至最低。本研究探讨了通过内窥镜鼻内入路 (EEA) 在尸体标本中进行选择性 AH 的可行性。

方法

在来自三个注射人体尸体的六个半球中研究了内侧颞叶的内窥镜解剖结构和成功选择性 AH 的可行性。基于选择性 AH 前后的 CT 和 MRI 研究以及解剖过程中进行的测量，对切除范围和暴露角度进行了定量分析。

结果

EEA V1-V2 走廊提供了一条直接且符合逻辑的进入颞叶内侧的路线，遵循其自然轨迹，没有脑回缩，翼腭窝的暴露最小。内侧颞叶的组成部分与经颅入路一样有选择性和容易地切除，但不会损害外侧颞叶或 Meyer 环的结构。

结论

EEA V1-V2 走廊展示了其对尸体标本中颞叶内侧的选择性可切除性和可及性。这种方法的临床价值应该由具有 EEA 显微外科技能和经验的外科医生负责任地探索。