amygdalohippocampectomy
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| name = Amygdalohippocampectomy
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| image = Image:Hippocampus.png
| caption = Hippocampi
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| specialty = neurology
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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 |author2=Kahana M.J. |author3=Caplan J.B. |author4=Fields T.A. |author5=Isham E.A. |author6=Newman E.L. |author7=Fried I. | title =Cellular networks underlying human spatial navigation | journal =Nature | volume =425| issue =6954 | pages =184–188 | year =2003 | url =http://memory.psych.upenn.edu/Publications#EkstEtal03 | doi = 10.1038/nature01964| pmid =12968182 | access-date =2007-02-11| citeseerx =10.1.1.408.4443 | bibcode =2003Natur.425..184E | s2cid =1673654 }} 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|pages=S68–76; discussion S92–6 |year=2000 |issue=Suppl 1 |pmid=10830331|doi=10.1017/S031716710000069X |doi-access=free }} 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 also used to cure severe aggression, and anxiety usually as a last resort treatment. It is an effective treatment for most patients. However, possible adverse side effects include impaired memory, dangerous risktaking behaviours, and defects in visual perception.
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Procedure
The amygdalohippocampectomy 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 either have failed all first-line treatments for epilepsy, or if all therapy fails for severe aggression and anxiety. {{cite journal |vauthors=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 |archive-url=https://web.archive.org/web/20071027053333/http://www.emergemd.com/bniq/article.asp?article_ref_id=15-1-4|archive-date=27 October 2007}}
The selective amygdalohippocampectomy will remove only the offending portions of the hippocampus and amygdala.{{cite journal |vauthors=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 |date=January 2007 |pmid=17222120 |doi=10.1111/j.1468-1331.2006.01565.x|s2cid=39969344 }} 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.
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 |doi=10.1212/01.WNL.0000055086.35806.2D |vauthors=Engel J, Wiebe S, French J |title=Practice parameter: Temporal lobe and localized neocortical resections for epilepsy |journal=Neurology |volume=60 |issue=4 |pages=538–47 |date=25 February 2003|url=http://www.neurology.org/cgi/content/full/60/4/538 |pmid=12601090 |display-authors=etal|doi-access=free }}
Some patients report defects in visual perception{{cite journal |vauthors=Mengesha T, Abu-Ata M, Haas KF, Lavin PJ, Sun DA, Konrad PE, Pearson M, Wang L, Song Y, Abou-Khalil BW |date=September 2009 |title=Visual field defects after selective amygdalohippocampectomy and standard temporal lobectomy |journal=J Neuroophthalmol |volume=29 |issue=3 |pages=208–213 |doi=10.1097/WNO.0b013e3181b41262 |pmid=19726943|s2cid=9337371 |doi-access=free }} and impaired memory function.{{cite journal |vauthors=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|doi-access= |s2cid=33114152 }} Almost all of them reported not feeling as much fear as before, hence inducing the risk-taking behaviour. It can also cause behavioural aggression, and can lower the effects of anxiety and Asperger’s Syndrome.
References
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Category:Surgical removal procedures