Anteromesial Temporal Lobectomy

Anteromesial temporal lobectomy (AMTL) is the most commonly performed procedure for surgical treatment of the patients with temporal lobe epilepsy (TLE). In this technique, anterior temporal neocortex is resected along the mesial temporal structures, including amygdala and hippocampus. This chapter gives a step-by-step description of the surgical technique we use for AMTL. However, surgical technique may change based on the underlying lesion and extent of the epileptogenic zone, especially in patients with cortical dysplasia. In general, our temporal lobe resection includes the anterior 3.5 cm of the temporal neocortex in the dominant hemisphere by sparing most of the superior temporal gyrus. Our resection also includes the uncus, amygdala, and an approximately 3 cm length of the hippocampus-parahippocampus as an en bloc specimen. This technique may be modified depending on the patient's age, imaging, and electrophysiological characteristics. The most common neuropathological substrates in children are cortical dysplasia and neoplasms followed by gliosis and mesial temporal sclerosis (MTS). Temporal lobe resection is a safe and effective surgical technique in the management of TLE with reported seizure control rates between 60 and 80%.