BACKGROUND Patients with a lesion within the amygdala and uncus may develop temporal lobe epilepsy despite having functional mesial structures. Resection of functional hippocampus and surrounding structures may lead to unacceptable iatrogenic deficits. To our knowledge, there is limited descriptions of surgical techniques for selectively resecting the amygdala and uncus lesions while preserving the hippocampus in patients with language-dominant temporal lobe pathology. METHODS Thirteen patients with language-dominant temporal lobe epilepsy related to amygdala-centric lesions were identified. Patients with sclerosis of the mesial structures or evidence of pathology outside of the amygdala-uncus region were excluded. Neuropsychological evaluation confirmed normal function of the mesial structures ipsilateral to the lesion. All patients were worked up with video-EEG, high-resolution brain MRI, neuro-psychology evaluation, and either Wada or functional MRI testing. RESULTS All patients underwent selective resection of the lesion including amygdala and uncus with preservation of the hippocampus via a transcortical inferior temporal gyrus approach to the mesial temporal lobe. Pathology was compatible with glioneuronal tumors. Post-operative MRI demonstrated complete resection in all patients. Eight of the thirteen patients underwent post-operative neuropsychology evaluations and did not demonstrate any significant decline in tasks of delayed verbal recall or visual memory based on the Rey Auditory Verbal Learning Test (RAVLT). One patient showed a slight decrease in confrontation naming using the Boston Naming Test (BNT). Seizure freedom (Engel class I) was achieved in 12 of 13 patients. CONCLUSION Selective transcortical amygdala and uncus resection with hippocampus preservation may be a reasonable way to achieve seizure control while sparing functional mesial structures.

中文翻译：

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杏仁核和钩回手术：一系列胶质神经元肿瘤病例。

背景尽管具有功能性的近中结构，杏仁核和钩回内有病变的患者可能会发展为颞叶癫痫。切除功能性海马体和周围结构可能导致不可接受的医源性缺陷。据我们所知，关于选择性切除杏仁核和钩爪病变同时保留海马体的以语言为主的颞叶病变的手术技术描述有限。方法 确定了 13 名与以杏仁核为中心的病变相关的语言为主的颞叶癫痫患者。具有近中结构硬化或杏仁核-钩部区域外病理证据的患者被排除在外。神经心理学评估证实病变同侧的近中结构功能正常。所有患者都接受了视频脑电图、高分辨率脑部 MRI、神经心理学评估以及 Wada 或功能性 MRI 测试。结果 所有患者均通过经皮层颞下回入路至颞叶内侧进行选择性切除包括杏仁核和钩部在内的病变并保留海马体。病理学与神经神经元肿瘤相容。术后 MRI 显示所有患者均完全切除。13 名患者中有 8 名接受了术后神经心理学评估，根据 Rey 听觉言语学习测试 (RAVLT)，延迟言语回忆或视觉记忆任务没有任何显着下降。一名患者使用波士顿命名测试 (BNT) 显示对抗命名略有减少。13 名患者中有 12 名达到无癫痫发作（Engel I 级）。结论 保留海马体的选择性经皮质杏仁核和钩端切除术可能是实现癫痫控制同时保留功能性近中结构的合理方法。