amygdalohippocampectomy

Amygdalahippocampectomy is a neurosurgical procedure in which the amygdala and hippocampus, structures deep within the medial temporal lobe, are surgically removed to treat epilepsy that remains uncontrolled by medications. The operation targets mesial temporal lobe epilepsy, typically associated with hippocampal sclerosis or other focal abnormalities in the limbic system, with the aim of removing the epileptogenic network while preserving surrounding cortex when possible.

Indications for amygdalohippocampectomy include drug-resistant focal epilepsy with seizures arising from the mesial temporal structures, concordant imaging and electroencephalographic data, and a reasonably preserved baseline language and cognitive function. It is most commonly considered when seizures originate predominantly from the left or right mesial temporal region.

Surgical approaches vary. The procedure can be performed as a selective amygdalohippocampectomy, removing only the amygdala and hippocampus, or as part of a broader resection. Techniques may be transsylvian, transcortical, or subtemporal, and different approaches attempt to minimize damage to lateral temporal cortex and preserve parahippocampal tissues when feasible.

Outcomes for mesial temporal epilepsy are favorable in many cases, with a substantial proportion of patients achieving seizure freedom (Engel Class I in roughly half to three-quarters of selected series). Cognitive effects are possible, particularly on memory, and risks include verbal memory decline with left-sided resections, visual field defects, infection, hemorrhage, and general surgical risks. Long-term follow-up remains important to monitor seizure control and cognitive function.