• Abhidha Shah, Aditya Lunawat, Sukhdeep Singh Jhawar, Aimee Goel, and Atul Goel.
• Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai.
• World Neurosurg. 2022 Jan 1; 157: e156-e165.

ObjectiveThe white fiber and gross anatomy relevant for performing amygdalohippocampectomy through the middle temporal gyrus approach for mesial temporal sclerosis has been depicted by white fiber dissection.MethodsThree previously frozen and formalin fixed cerebral hemispheres were studied. The Klingler method of fiber dissection was used to study the anatomy. The primary tools used were hand-made wooden spatulas, forceps, and microscissors. The anatomy of the amygdala and hippocampus and the landmarks for performing the disconnection during epilepsy surgery are presented. The white fibers at risk during the middle temporal gyrus approach were studied.ResultsThe white fiber tracts at risk during the middle temporal gyrus approach for epilepsy surgery are the fibers of the inferior frontooccipital fasciculus, temporal extension of the anterior commissure, Meyer loop of the optic radiation, and uncinate fasciculus. On the basis of our anatomic dissections, we present a novel entry point into the temporal horn, potentially minimizing injury to the fibers of the sagittal stratum. We also propose novel landmarks to perform the amygdala disconnection in mesial temporal sclerosis.ConclusionsThe middle temporal gyrus is a commonly used approach to perform temporal lobectomy and amygdalohippocampectomy for patients with mesial temporal sclerosis. The anatomy relevant to the approach as presented will aid while performing epilepsy surgery.Copyright © 2021 Elsevier Inc. All rights reserved.

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