Endoscopic transventricular selective amygdalohippocampectomy: Cadaveric demonstration of a new operative approach

Objective: The microsurgical anatomy of the temporal region has been well described. However, there is a paucity of information about the transventricular endoscopic anatomy of the mesial temporal lobe, and little is known about endoscopic approaches to this region. In this report, we describe the technique of endoscopic amygdalohippocampectomy (AH). The endoscopic anatomy of the mesial temporal region both before and after AH is shown. Methods: We used 4 silicon-injected cadaver heads for the study in our minimally invasive neurosurgery laboratory. The lateral ventricle was accessed through an occipital burr hole. Results: Predissection transventricular endoscopic anatomy of this region showed the choroid plexus, hippocampus, amygdala, choroid fissure, and collateral eminence. The hippocampus, parahippocampal gyrus, and amygdala were removed endoscopically, keeping the pia on the inferior surface of the mesial temporal region intact. Postdissection anatomy of the mesial temporal region showed a clear view of the brainstem, posterior cerebral vessels, choroidal vessels, and tentorium. Conclusions: We studied the transventricular endoscopic anatomy of the mesial temporal region and described a technique for safe endoscopic AH. The advantages and potential risks of endoscopic AH are discussed, along with suggestions for minimizing complications. We believe that knowledge of the endoscopic anatomy of the mesial temporal lobe will be useful for endoscopic AH and the removal of other lesions in this region.