Selective amygdalohippocampectomy via the paramedian supracerebellar-transtentorial approach for mediobasal temporal epilepsy

Selective amygdalohippocampectomy via the pterional transsylvian approach is a feasible option for many patients with mediobasal temporal epilepsy. However, it may be insufficient for patients when the posterior hippocampal region is involved. The paramedian supracerebellar transtentorial approach offers precise anatomical orientation when exposing the entire length of the mediobasal temporal region, including the fusiform gyrus. In addition, this approach allows selective amygdalohippocampectomy without any neocortical damage. This video presents the successful treatment of a patient with posterior hippocampal sclerosis and mediobasal temporal epilepsy through the paramedian supracerebellar transtentorial approach. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2447