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CC BY-NC-ND 4.0 · J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0043-1771276
Original Article

Ultrasound-Navigated Multiple Hippocampal Transections: An Anatomical Study

Jan Sroubek 
1   Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
2   Department of Neurosurgery, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
,
Lenka Kramska
3   Department of Clinical Psychology, Na Homolce Hospital, Prague, Czech Republic
,
Tomas Cesak
2   Department of Neurosurgery, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
,
Jana Amlerova
4   Department of Neurology, Motol University Hospital, Praha, Czech Republic
,
Jiri Keller
5   Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
,
Zdenek Vojtech
6   Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
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Abstract

Background Multiple hippocampal transection (MHT) is a surgical technique used for the treatment of drug-resistant mesial temporal lobe epilepsy in situations where standard procedures would pose a high risk for memory deterioration. During MHT, the longitudinal fibers of the hippocampus, implicated in epilepsy spreading, are interrupted, while the transverse memory circuits are spared. The extent of MHT is governed by intraoperative electrocorticography; abolition of epileptic discharges serves as an end point to terminate the transection. In other words, the aim of MHT is not the anatomical completeness of hippocampal transection. In contrast, we hypothesize that only the complete transection of hippocampal cross-section is needed to durably terminate epilepsy, avoiding possible postoperative reorganization of longitudinal pathways. Here, we report an anatomical study designed to evaluate the feasibility of complete transection of hippocampus with the aid of ultrasound neuronavigation and we propose new instruments to reach this goal.

Methods Five cadaveric brains were analyzed in this study. MHT was performed on both sides of each brain either with or without ultrasound neuronavigation. The percentage of transected cross-section of the hippocampus was measured using magnetic resonance imaging (MRI) and both sides were compared.

Results The ultrasound-guided MHTs were more likely to achieve complete hippocampal transection compared with the nonnavigated MHT transection (73 vs 58%; p < 0.01). Our study also allowed us to propose specialized transectors to minimize invasivity of this procedure.

Conclusion Completeness of MHT can be better reached with the aid of an ultrasound neuronavigation system; modified instruments for this procedure were also designed.

Keywords

temporal lobe - epilepsy - multiple hippocampal transection - memory - ultrasound guidance


Publication History

Received: 28 September 2022

Accepted: 03 April 2023

Article published online:
22 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Spencer DD, Spencer SS, Mattson RH, Williamson PD, Novelly RA. Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy. Neurosurgery 1984; 15 (05) 667-671
    CrossrefPubMedGoogle Scholar
  • 2 Wieser HG, Yaşargil MG. Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol 1982; 17 (06) 445-457
    CrossrefPubMedGoogle Scholar
  • 3 Téllez-Zenteno JF, Hernández Ronquillo L, Moien-Afshari F, Wiebe S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res 2010; 89 (2–3): 310-318
    CrossrefPubMedGoogle Scholar
  • 4 Engel Jr J. The current place of epilepsy surgery. Curr Opin Neurol 2018; 31 (02) 192-197
    CrossrefPubMedGoogle Scholar
  • 5 Kang JY, Sperling MR. Epileptologist's view: laser interstitial thermal ablation for treatment of temporal lobe epilepsy. Epilepsy Res 2018; 142: 149-152
    CrossrefPubMedGoogle Scholar
  • 6 Losarcos NG, Miller J, Fastenau P. et al. Stereotactic-EEG-guided radiofrequency multiple hippocampal transection (SEEG-guided-RF-MHT) for the treatment of mesial temporal lobe epilepsy: a minimally invasive method for diagnosis and treatment. Epileptic Disord 2021; 23 (05) 682-694
    CrossrefPubMedGoogle Scholar
  • 7 Umeoka SC, Lüders HO, Turnbull JP, Koubeissi MZ, Maciunas RJ. Requirement of longitudinal synchrony of epileptiform discharges in the hippocampus for seizure generation: a pilot study. J Neurosurg 2012; 116 (03) 513-524
    CrossrefPubMedGoogle Scholar
  • 8 Patil AA, Chamczuk AJ, Andrews RV. Hippocampal transections for epilepsy. Neurosurg Clin N Am 2016; 27 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 9 Suzuki H, Sugano H, Nakajima M. et al. The epileptogenic zone in pharmaco-resistant temporal lobe epilepsy with amygdala enlargement. Epileptic Disord 2019; 21 (03) 252-264
    CrossrefPubMedGoogle Scholar
  • 10 Warsi N, Thiong'o GM, Zuccato J, Ibrahim GM. Multiple hippocampal transections: post-operative memory outcomes and seizure control. Epilepsy Behav 2019; 100 (Pt A): 106496
    CrossrefPubMedGoogle Scholar
  • 11 Roessler K, Heynold E, Buchfelder M, Stefan H, Hamer HM. Current value of intraoperative electrocorticography (iopECoG). Epilepsy Behav 2019; 91: 20-24
    CrossrefPubMedGoogle Scholar
  • 12 Schwartz TH, Bazil CW, Walczak TS, Chan S, Pedley TA, Goodman RR. The predictive value of intraoperative electrocorticography in resections for limbic epilepsy associated with mesial temporal sclerosis. Neurosurgery 1997; 40 (02) 302-309 , discussion 309–311
    CrossrefPubMedGoogle Scholar
  • 13 Herlopian A, Shihabuddin B. Predictive value of electrocorticography in patients with mesial temporal lobe epilepsy undergoing selective amygdalohippocampectomy. J Clin Neurophysiol 2017; 34 (04) 370-374
    CrossrefPubMedGoogle Scholar
  • 14 Ishida W, Morino M, Matsumoto T, Casaos J, Ramhmdani S, Lo SL. Hippocampal transection plus tumor resection as a novel surgical treatment for temporal lobe epilepsy associated with cerebral cavernous malformations. World Neurosurg 2018; 119: e209-e215
    CrossrefPubMedGoogle Scholar
  • 15 Usami K, Kubota M, Kawai K. et al. Long-term outcome and neuroradiologic changes after multiple hippocampal transection combined with multiple subpial transection or lesionectomy for temporal lobe epilepsy. Epilepsia 2016; 57 (06) 931-940
    CrossrefPubMedGoogle Scholar
  • 16 Koubeissi MZ, Kahriman E, Fastenau P. et al. Multiple hippocampal transections for intractable hippocampal epilepsy: Seizure outcome. Epilepsy Behav 2016; 58: 86-90
    CrossrefPubMedGoogle Scholar
  • 17 Chen X, Sure U, Haag A. et al. Predictive value of electrocorticography in epilepsy patients with unilateral hippocampal sclerosis undergoing selective amygdalohippocampectomy. Neurosurg Rev 2006; 29 (02) 108-113
    CrossrefPubMedGoogle Scholar
  • 18 Duvernoy HM, Cattin F, Risold PY, Vannson JL, Gaudron M. The Human Hippocampus: Functional Anatomy, Vascularization and Serial Sections with MRI. 4th ed. Springer; 2013
    CrossrefGoogle Scholar
  • 19 Spencer SS, Schramm J, Wyler A. et al. Multiple subpial transection for intractable partial epilepsy: an international meta-analysis. Epilepsia 2002; 43 (02) 141-145
    CrossrefPubMedGoogle Scholar
  • 20 Orbach D, Romanelli P, Devinsky O, Doyle W. Late seizure recurrence after multiple subpial transections. Epilepsia 2001; 42 (10) 1316-1319
    CrossrefPubMedGoogle Scholar
  • 21 Schramm J, Aliashkevich AF, Grunwald T. Multiple subpial transections: outcome and complications in 20 patients who did not undergo resection. J Neurosurg 2002; 97 (01) 39-47
    CrossrefPubMedGoogle Scholar
  • 22 Pitskhelauri D, Kudieva E, Kamenetskaya M. et al. Multiple hippocampal transections for mesial temporal lobe epilepsy. Surg Neurol Int 2021; 12: 372
    CrossrefPubMedGoogle Scholar