内側側頭葉てんかんに対する外科治療—手術に必要となる解剖学的理解を中心に

Surgical Treatment of Mesial Temporal Lobe Epilepsy Focusing on Anatomical Understanding

Point

・内側側頭葉てんかんに対する海馬扁桃体摘出術は有効な外科治療である．

・手術アプローチには前側頭葉切除，経シルビウス裂到達法，経皮質到達法などが用いられる．

・海馬硬化がなく記銘力が保たれている優位側例では海馬多切術も有効である．

　Surgical treatment is an effective option for medically intractable epilepsy. Amygdalohippocampectomy for mesial temporal lobe epilepsy is a surgically remediable epileptic syndrome. It is a well-established surgery and various approaches to the mesial temporal lobe have been reported. To reduce the complication rate, surgeons should have sufficient knowledge of anatomy in the mesial temporal region.

　Here, we summarize the surgical treatments for mesial temporal lobe epilepsy, focusing on anatomical understanding. We described in detail the surgical anatomy of amygdalohippocampectomy and various approaches to the mesial temporal region. In addition, we describe hippocampal transection aimed at preserving memory function, which is an alternative surgery in patients without hippocampal sclerosis.

　An anatomical understanding of the mesial temporal region helps surgeons not only in the field of epilepsy surgery, but also in other fields of neurosurgery, such as brain tumor and vascular surgery.