Introduction. The common surgical approach for standard temporal lobectomy is a question-mark skin incision and a frontotemporal craniotomy. Herein, we describe minicraniotomy approach through a linear skin incision for standard temporal lobectomy. Methods. A retrospective observational cohort study was conducted for a group of consecutive 21 adult patients (group I) who underwent minicraniotomy for standard temporal lobectomy utilizing a linear skin incision. This group was compared to a consecutive 17 adult patients (group II) who previously underwent a reverse question-mark skin incision and standard frontotemporal craniotomy. Results. The mean age was 29 and 23 for groups I and II, respectively. The mean estimated blood loss was 190？mL and 280？mL in groups I and II, respectively ( ). Three patients in group II developed chronic postcraniotomy headache compared to none in group I. Cosmetic outcome was excellent in group I while 4 patients in group II developed disfiguring depression at lateral sphenoid wing and anterior temple. In group I 17 out of 21 became seizure-free at one-year followup. Conclusion. Minicraniotomy through a linear skin incision is a sufficient surgical approach for effective standard temporal lobectomy and it has an excellent cosmetic outcome. 1. Introduction Several modifications have been made to the surgical techniques and methods used to treat temporal lobe epilepsy over the last 50 years [1–4]. Performing a standard anterior temporal lobectomy consists of resecting the lateral temporal and mesial temporal structures, either en bloc or separately as popularized by Penfield [1]. The anteromedial temporal resection technique was developed by Spencer to preserve lateral temporal cortex function and to access the mesial temporal structures through the temporal pole corridor [5]. Both procedures are done traditionally through a question-mark skin incision and frontotemporal craniotomy [6]. Conversely, selective transcortical amygdalohippocampectomy is done mainly through a smaller question-mark or vertical temporal skin incision and temporal minicraniotomy [7]. A minimally invasive neurosurgical approach has shown a benefit in reducing morbidity and producing better cosmetic results [8–10]. Several modifications to temporal lobe resective surgery have been based either on resection of the epileptogenic zone, assisted by the use of electrocorticography and cortical mapping to avoid functional deficits, or on resection of the seizure onset zone, as with selective amygdalohippocampectomy. In this cohort study, we report a minimally
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