Name of the Procedure:

Craniotomy with elevation of bone flap; Selective Amygdalohippocampectomy

Summary

A craniotomy with elevation of bone flap for selective amygdalohippocampectomy is a surgical procedure where a piece of the skull is temporarily removed to access the brain. Specifically, it involves removing parts of the amygdala and hippocampus to treat epilepsy or other brain disorders.

Purpose

This procedure is primarily used to treat patients with epilepsy that does not respond to medication. The goals are to reduce or eliminate seizures and improve the quality of life by targeting the specific brain regions responsible for the seizures.

Indications

• Uncontrolled epilepsy
• Focal seizures originating from the amygdala or hippocampus
• Patients not responding to anti-seizure medications
• Candidates who have undergone pre-surgical evaluations such as EEG, MRI, and comprehensive neuropsychological testing

Preparation

• Patients are usually required to fast for at least 8 hours before the surgery.
• Medication adjustments may be necessary.
• Preoperative tests include MRI, EEG, and blood tests.
• A thorough neurological examination and consultation with the surgical team are conducted.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgical team shaves and sterilizes the scalp.
3. An incision is made in the scalp, and a section of the skull (bone flap) is removed.
4. The dura mater (brain covering) is opened to expose the brain.
5. Using microsurgical techniques, the surgeon carefully removes the targeted portions of the amygdala and hippocampus.
6. The dura mater is then sutured back, and the bone flap is reattached using plates and screws.
7. The scalp incision is closed with sutures or staples.

Duration

The procedure typically takes 4-6 hours.

Setting

Performed in a hospital operating room equipped for neurosurgery.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Neurophysiologist (optional)

Risks and Complications

• Infection
• Bleeding or hematoma
• Swelling of the brain
• Neurological deficits such as memory loss or changes in behavior
• Seizure recurrence
• Complications related to anesthesia

Benefits

• Significant reduction or complete cessation of seizures
• Improved quality of life
• Reduced need for anti-seizure medications
• Benefits can be realized shortly after recovery from surgery

Recovery

• Initial hospital stay of about 3-7 days for monitoring and recovery.
• Gradual return to normal activities over a few weeks.
• Follow-up appointments for neurological assessments and imaging.
• Physical and cognitive rehabilitation may be necessary.
• Restrictions on activities such as heavy lifting and driving until fully cleared by the medical team.

Alternatives

• Continued medication management
• Vagus nerve stimulation (VNS)
• Responsive neurostimulation (RNS)
• Dietary therapy (e.g., ketogenic diet)
• Pros and cons vary; alternatives may result in less invasive treatment but might be less effective for some patients.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not experience pain. Post-surgery, the patient may experience soreness at the incision site, headaches, fatigue, and temporary neurological symptoms. Pain management includes medications and comfort measures, and the healthcare team will provide specific guidelines for a smooth recovery process.