Experiences and Reflections about Selective Amygdalohippocampectomy ( AHE )

Historical view of the development of selective amygdalo-hippocampectomy for the treatment of the intractable temporal limbic seizures. Preservation of neopallial structures and functions. Erfahrungen mit der selektiven Amygdalo-Hippokampektomie Historische Sicht der Entwicklung der selektiven Amygdalo-Hippokampektomie als Behandlung thera-pieresistenter temporaler limbischer Anfälle. Bewah-rung der neopallialen Strukturen und Funktionen. Expériences faites avec l'amygdalo-hippocampectomie Historique de l'évolution de l'amygdalo-hippocam-pectomie sélective en tant qu'approche thérapeutique des crises du lobe temporal rebelles aux traitements. Conservation des structures et fonctions néopalliales. Monday, January 4 th , 1953 will remain in my memory as a very special day for two reasons. On this date, I started my training in neurosurgery at the University Hospital in Zurich, and also on this, the first day in my chosen specialty, I had the unique opportunity to observe temporal lobe surgery on a young male, who suffered from intractable psychomotor seizures. The continuous ongoing recording of electrocortical activities from the temporal lobe were being attentively observed by Professor Rudolf Hess and his team, who from time to time gave information regarding electro-corti-cography (ECOG) analysis to the surgeon, Professor Hugo Krayenbuehl, or related instructions to change the position of some of the electrodes. The process of the surgical procedure impressed me, not only from the viewpoint of the installations, which were recording electrocortical activities in real time, but also due to the fact that surgery was being performed under local anesthesia, allowing examination of sensomotoric functions of the patient's extremities, and occasional exchange of dialogue with the sedated patient, to evaluate his level of consciousness. Depending on the analysis of electro-cortical activities, the neopallial temporal gyri were removed " en block " from the temporal pole, some 4 cm posteriorly and deeper into the white matter to the temporal horn and uncinate gyrus. Professor H. Krayenbuehl had been performing the standard Penfield anterior two-thirds temporal lobec-tomy since 1939 [1, 2]. His surgical decisions were based on a combination of clinical features and findings, on electro-corticographic recordings. He had a passionate interest for epilepsy surgery, and at every opportunity referred to the despair epilepsy patients suffer with their seizures, and how urgent the need for diagnostic and therapeutic advancement in this field was. From 1957-1965 I was involved in stereotactic procedures for the treatment of movement disorders (in particular patients with Parkinson's disease), and for the treatment of chronic pain in patients with amputated limbs. I used the stereotactic frame designed by Pro-and …