Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Abstract

Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis of outcomes

“…Finally, 13 studies dealing with MRgLITT [21][22][23][24][25][26][27][28][29][30][31] and six dealing with RFA [32][33][34][35][36] were included (Figure 1). For ATL and sAHE, four RCTs 4,37-39 and 20 comparative studies [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] were included.…”

Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy

“…There were more studies that were included in our meta-analysis compared with prior meta-analyses by Josephson et al 5 and Hu et al 4. In particular, there were seven studies that were not included in prior meta-analyses—Arruda et al ,39 Renowden et al ,48 Tahir et al ,51 Sagher et al ,49 Bujarski et al ,41 Wendling et al 54 and Nascimento et al 46—which demonstrated no significant difference in seizure-free outcome of ATL versus SAH. The inclusion of new data from these studies may have contributed to differences in this study’s conclusion relative to prior meta-analyses.…”

Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy

“…The studies that have compared neurocognitive outcomes between SAH and TLR are reviewed in Table 3. 33,[37][38][39][49][50][51][52][53][54][55][56] In general, these are small case series or retrospective cohort studies (level 4 evidence).…”