New Minimally Invasive Endoscopic Surgical Approach for Patients With Temporal Lobe Epilepsy

A multidisciplinary surgical team from the UPMC Comprehensive Epilepsy Center, the UPMC Center for Cranial Base Surgery, and the Departments of Neurological Surgery, Neurology, and Otolaryngology has developed a new endoscopic sublabial transmaxillary approach called the Endoscopic Far-Anterior Temporal Pole Approach designed to treat cases of medically intractable (drug-resistant) mesial temporal lobe epilepsy.

The surgical team included Jorge Gonzalez-Martinez, MD, PhD, UPMC Endowed Chair in Epilepsy Surgery, co-director of the UPMC Comprehensive Epilepsy Center, and director of the Epilepsy and Movement Disorders Program in the Department of Neurological Surgery; Paul A. Gardner, MD, Peter J. Jannetta Professor of neurological surgery, neurosurgical director of the UPMC Center for Cranial Base Surgery, executive vice chair of surgical services, and director of the Surgical Neuroanatomy Laboratory; and Carl Snyderman, MD, MBA, professor of Otolaryngology and Neurological Surgery, and co-director of the UPMC Center for Cranial Base Surgery.  

The work to develop this new approach and expand the surgical treatment options for intractable mesial temporal lobe epilepsy builds upon UPMC’s decades of excellence and clinical firsts in endoscopic surgical approaches for epilepsy, brain and skull-base tumors, and head and neck cancers.

Anatomic studies to realize the optimal approach to the mesial temporal structures, including the temporal pole, hippocampus and parahippocampus, and the amygdala, were subsequently followed by surgeries in the first four patients to undergo the procedure, the first of which occurred in May 2020.

This is the first time an endoscopic approach has been attempted to reach and resect mesial temporal structures making up the epileptogenic zone for medically refractory focal epilepsy. The approach allows for a more precise and complete resection of target tissues while avoiding cortical areas important to cognition and the need for a craniotomy.

Follow-up data were collected on patient adverse events, seizure activity, and cognitive outcomes. In general, postoperative complications were minor or unremarkable. Notably, three of the four patients achieved a complete control of seizures and in one patient a significant reduction in their seizures frequency and severity.

Full details of the design of the surgical approach and the eight-month postoperative patient outcomes from the initial four cases will be forthcoming in a new manuscript from Dr. Gonzalez-Martinez et al., along with a subsequent paper on the initial anatomical studies and findings.

Learn More

To learn more about the new procedure or discuss a patient case for possible referral, please contact the UPMC Department of Neurological Surgery at 412-647-3685.