Full Description
Although in the last few years more experience in the field of epilepsy surgery with amygdalo-hippocampectomies was gained in several hos- pitals, a detailed microanatomical and microsurgical description meet- ing the requirements of the modern neurosurgeon has not been achieved so far. Recently the allocortex - the so-called "limbic system" - has doubtlessly received more attention, as can be gathered from the recently published monography by Duvernoy, which however only considers anatomical points of view. Lately not only epilepsies but also tumorsurgical operations on the border between temporal lobe and basal ganglia can be - thanks to modern MR-examinations - carried out more exactly. Here the tumor-conditioned deformations of the temporo-medial area and its connections with the adjacent basal gang- lia as well as their blood supply are of great importance. Using conven- tional techniques the postoperative morbidity was especially high until recently. The author has at the suggestion of his teacher G. M. Ya argil approached the problem first of all morphologically by developing his own techniques of brain dissection.
After some developmental and topographic-anatomical descriptions he has described the vessel-supply by using injection-preparations. Particular aspects of A. chorioidea ant. with her lateral, medial and Tractus opticus penetrating perforat- ing arteries to the basal ganglia and Capsula into have never been described in such a convincing manner before. It is of great importance in the operative removal of the amygdalo- hippocampal area to realize that it is not sufficient to preserve the A.
Contents
I. Morphology of the Temporo-Medial Region.- 1. Phylogenetic Aspects.- 2. Surgical Topography.- 3. Microsurgical Anatomy.- 3.1. Cisternal Relationships.- 3.2. Vascular Relationships.- 3.2.1. Arteries of the Temporo-Medial Region.- 3.2.2. Veins of the Temporo-Medial Region.- II. Clinical Aspects of Temporo-Medial Lesions.- 1. Epileptic Seizures.- 1.1. Ictal Symptoms...- 1.2. Grouped Symptoms.- 1.2.1. First Step: Nature of the Episodes.- 1.2.2. Second Step: Lateralisation.- 1.2.3. Third Step: Origin of CPS.- 1.2.4. Fourth Step: Spread of CPS.- 2. Memory and Learning.- 2.1. Non-Invasive Testing.- 2.2. Invasive Testing.- 3. Mental Changes.- 4. Ocular Signs.- III. Neuroimaging of Temporo-Medial Lesions.- 1. Computerized Tomography (CT).- 2. Magnetic Resonance Imaging (MR).- 3. Angiography.- IV. Functional Evaluation.- 1. Electrophysiological Evaluation..- 2. Functional Imaging.- V. Presurgical Evaluation Protocol.- VI. Surgery of the Temporo-Medial Region.- 1. Indication.- 2. Surgical Approaches.- 2.1. Trans-sulcal Approach.- 2.2. Inferior Temporal Approach.- 2.3. Retroinsular Transventricular Approach.- 2.3.1. Positioning of the Head.- 2.3.2. Skin Incision and Craniotomy.- 2.3.3. Opening of the Basal Cisterns.- 2.3.4. Opening of the Sylvian Cistern.- 2.3.5. Retrosylvian Exploration.- 2.3.6. Intraventricular Dissection.- 2.4. Interhemispheric Transatrial Approach.- 2.4.1. Positioning of the Head.- 2.4.2. Skin Incision and Craniotomy.- 2.4.3. Interhemispheric Exploration.- 2.4.4. Opening of the Ventricular Atrium.- 2.4.5. Atrial Exploration.- 3. Planning of the Surgical Approach.- 3.1. Planning Surgery on CT.- 3.1.1. Basal Compartment.- 3.1.2. Dorsal Compartment.- 3.2. Planning Surgery on MR.- 3.2.1. Microsurgical Landmarks.- 3.2.2. Functional Component of the Lesion.- 3.2.3. Invisible Structures.- 3.2.4. Simulation of the Operative View.- VII. Outcome of Surgery.- 1. Complications.- 2. Seizures.- 3. Psychosocial Adaptation.- VIII. Neuropathological Aspects.- IX. Conclusions.- References.
