Anatomic investigation of the trajectory for stereotactic laser amygdalohippocampectomy

Vanessa M. Holanda, Abuzer Gungor, Serhat Baydin, Erik H. Middlebrooks, Shabbar Danish

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) has emerged as a promising treatment for mesial temporal lobe epilepsy. Surgeons must understand the relevant anatomy that is traversed by the catheter and affected by ablation. OBJECTIVE: To study the anatomic structures crossed by the LITT catheter until it reaches the amygdala. METHODS: Three human cadaveric heads were implanted with catheters using a frameless stereotactic technique. The VisualaseR system (Medtronic, Dublin, Ireland) was utilized to ablate along the trajectory. Coronal and oblique axial slices were created. Fiber tract dissections were performed in a lateral-medial and inferior-superior scheme. Magnetic resonance tractography was acquired to illustrate the tracts dissected. RESULTS: Entry points occurred within 4 cm of the transverse and sagittal sinus, inferior to the lambdoid suture. The cortex of the inferior occipital gyrus was crossed in the region of the transverse occipital sulcus. The vertical occipital fasciculus was crossed en route to passing through the optic radiations. The catheter crossed through or inferior to the optic radiations before piercing the parahippocampal gyrus at about 4 cm from the skull. The catheter entered the hippocampus as it pierced the superior margin of the parahip-pocampus at 6 cm. The catheter entered the head of the hippocampus to lie inferolateral to the amygdala in the last centimeter of the trajectory. CONCLUSION: Understanding the anatomic principles of LITT catheter trajectories will improve the ability to perform this procedure. The current study is the first to examine the anatomy of this trajectory and will serve as the basis for future studies.

Original languageEnglish (US)
Pages (from-to)194-206
Number of pages13
JournalOperative Neurosurgery
Volume15
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Lasers
Catheters
Occipital Lobe
Hot Temperature
Amygdala
Hippocampus
Anatomy
Stereotaxic Techniques
Radiation
Transverse Sinuses
Parahippocampal Gyrus
Catheter Ablation
Temporal Lobe Epilepsy
Therapeutics
Ireland
Skull
Sutures
Dissection
Magnetic Resonance Spectroscopy
Head

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Surgery

Keywords

  • Amygdalohippocampectomy
  • Laser
  • Microsurgical Anatomy
  • White matter

Cite this

Holanda, Vanessa M. ; Gungor, Abuzer ; Baydin, Serhat ; Middlebrooks, Erik H. ; Danish, Shabbar. / Anatomic investigation of the trajectory for stereotactic laser amygdalohippocampectomy. In: Operative Neurosurgery. 2018 ; Vol. 15, No. 2. pp. 194-206.
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Anatomic investigation of the trajectory for stereotactic laser amygdalohippocampectomy. / Holanda, Vanessa M.; Gungor, Abuzer; Baydin, Serhat; Middlebrooks, Erik H.; Danish, Shabbar.

In: Operative Neurosurgery, Vol. 15, No. 2, 01.01.2018, p. 194-206.

Research output: Contribution to journalArticle

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AU - Gungor, Abuzer

AU - Baydin, Serhat

AU - Middlebrooks, Erik H.

AU - Danish, Shabbar

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