Abstracts

Rationale: The concern about selective amygdalohippocampectomy (SAHE) seems to be on the decline, after the systematic review presentation that anterior temporal lobectomy (ATL) surpasses the SHAE in term of seizure reduction, or by the recent rise of stereotactic laser interstitial thermal therapy (LATT) in North America. Considering that there is a room for the improvement in the diagnostic technology of epileptic foci, or LATT is not available in many countries, technique of SAHE should be maintained as it does not require unnecessary cortical resection. In our SAHE by anterior trans-sylvian approach focusing on minimizing the injury into the optic radiation, resection of the posterior component (i.e., hippocampal body and part of hippocampal tail) requires minimal cortical resection and utilization of surgical corridor mobilization. We hypothesized that, in this resection of posterior component, introduction of neuro-endoscopy results in the improvement of safer resection technique with certainty. Methods: Retrospectively reviewed. As a standard microscopic technique, we do not use brain retractor. Until the step of hippocampal body resection, our regular technique of SAHE was performed, and neuro-endoscope was introduced in the step of posterior component in some cases. Goldman Perimetry exam (GP) was performed postoperatively. Results: From October 2017 to April 2018, 12 cases of SAHE was performed by lead author (IT). In 10 out of 12 cases, neuro-endoscope was combined in the posterior component resection. The extent of resection was extended compared with our regular method. Post-operative GP showed no visual field defect (N=9), VFD within 30 degrees (N=2), contraction (N=1). Conclusions: We consider SAHE with minimal VFD should be maintained. This approach is hard to apply in the hippocampal transection, as our approach does not overlook the whole component of hippocampus from directly above. Funding: No funding