Memory outcome following transsylvian selective amygdalohippocampectomy in 62 patients with hippocampal sclerosis

Morino, Michiharu; Ichinose, Tsutomu; Uda, Takehiro; Kondo, Kyoko; Ohfuji, Satoko; Ohata, Kenji

doi:10.3171/2008.9.jns08247

Cited by 37 publications

(21 citation statements)

References 33 publications

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“…13 However, in patients without these pathological changes, functions of the hippocampus are thought to remain to some degree, and postoperative memory losses were reported to be more severe. 9 In our study we retrospectively analyzed 37 patients who underwent transsylvian HT for the treatment of MTLE without hippocampal sclerosis or atrophy.…”

Section: Discussionmentioning

confidence: 99%

“…A standard frontotemporal craniotomy can be performed, but slightly wider exposure of the temporal lobe is necessary to permit intraoperative electrocorticography. 13 After wide exposure of the sylvian fissure, the inferior periinsular sulcus can be identified at the most inferior point of the insular gyri. Along this sulcus, the inferior horn of the lateral ventricle is opened with a cortical incision 15 mm in length (Fig.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes

Uda¹,

Morino²,

Ito³

et al. 2013

JNS

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Object Amygdalohippocampectomy is a well-established, standard surgery for medically intractable mesial temporal lobe epilepsy (MTLE). However, in the case of MTLE without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with decreased postoperative memory function. Hippocampal transection (HT) has been developed to overcome this problem. In HT the hippocampus is not removed; rather, the longitudinal hippocampal circuits of epileptic activities are disrupted by transection of the pyramidal layer of the hippocampus. The present study describes a less invasive modification of HT (transsylvian HT) and presents the seizure and memory outcomes for this procedure. Methods Thirty-seven patients with MTLE (18 men and 19 women; age range 9–63 years; 19 with surgery on the right side and 18 with surgery on the left side; seizure onset from 3 to 34 years) who were treated with transsylvian HT were retrospectively analyzed. All patients had left-side language dominance, and follow-up periods ranged from 12 to 94 months (median 49 months). Seizure outcomes were evaluated for all patients by using the Engel classification. Memory function was evaluated for 22 patients based on 3 indices (verbal memory, nonverbal memory, and delayed recall), with those scores obtained using the Wechsler Memory Scale–Revised. Patients underwent evaluation of the memory function before and after surgery (6 months–1 year). Results Engel Class I (completely seizure free) was achieved in 25 patients (67.6%). Class II and Class III designation was achieved in 10 (27%) and 2 patients (5.4%), respectively. There were differences in memory outcome between the sides of operation. On the right side, verbal memory significantly increased postoperatively (p = 0.003) but nonverbal memory and delayed recall showed no significant change after the operation (p = 0.718 and p = 0.210, respectively). On the left side, all 3 indices (verbal memory, nonverbal memory, and delayed recall) showed no significant change (p = 0.331, p = 0.458, and p = 0.366, respectively). Conclusions Favorable seizure outcome and preservation of verbal memory were achieved with transsylvian HT for the treatment of MTLE without hippocampal atrophy or sclerosis.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes

Uda¹,

Morino²,

Ito³

et al. 2013

JNS

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“…[16] In the study of Morino et al, a significant improvement in verbal memory tests was found after surgery in 62 unilateral HS patients who underwent selective amygdalohippocampectomy. [17] Another study on patients who had anterior temporal lobectomy, disclosed that visual memory tests (especially 'delayed recall') were improved significantly during the postoperative 6th and 12th months when compared with the preoperative results. There was no difference in verbal memory tests, however.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Wada test and preoperative/postoperative memory in mesial temporal lobe epilepsy patients

Hanoğlu¹,

Yılmaz²,

Özkara³

et al. 2013

Epilepsi

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SummaryObjectives: To study the correlation between Wada memory test and neuropsychometric tests which were applied preoperatively to mesial temporal lobe epilepsy patients associated with hippocampal sclerosis (MTLE-HS) who had undergone selective amygdalohippocampectomy and find out the effects of early onset epileptic seizures on atypical memory dominance. Methods: Drug-resistant 27 patients (16 left, 11 right MTLE-HS) had video EEG, cranial MRI and Wada test preoperatively. Weschler visual subtest and verbal memory processing tests were applied to all patients before surgery and the first year after the operation. Results: The number of left hemisphere memory dominant patients was 6 (22.2%) and the number of atypical memory dominant patients was 21 (77.8%) according to the Wada test. There was a significant difference between the two groups when compared for epileptic seizure onset age; (p=0.042), and also a significant diffference when compared for HS (right/left) side (p=0.002). When we analyzed the correlation between preoperative and postoperative verbal and nonverbal tests and left memory Wada dominance; in verbal memory processing tests 'delayed recall' scores between groups were significant (p=0.042), on the other hand in patients with atypical memory dominance 'total learning' scores between groups were significant (p<0.001). Conclusion: As a result, we found that the earlier the onset of seizures, the more atypical the memory dominance (right or bilateral). The Wada test was effective for assessing verbal memory; on the other hand, it was inadequate for assessing visual memory dominance. If the scores of 'delayed recall' in verbal memory were high in the patients with typical verbal dominance and 'total learning' scores in the patients with atypical verbal dominance, the scores also tended to rise after the operation.Key words: Memory dominance; mesial temporal sclerosis; neuropsychometric tests; Wada test. ÖzetAmaç: Selektif amigdalohippokampektomi yapılan hipokampal sklerozla ilişkili mesial temporal lob epilepsili (HS-MTLE) hastalarda ameliyat öncesi dönemde yapılan Wada testi ile nöropsikometrik testler arasındaki ilişkiyi inceleyerek erken yaşta başlayan epilepsi nöbetlerinin belleğin atipikleşmesi üzerindeki etkilerini araştırmak. Gereç ve Yöntem: Medikal tedaviye dirençli 27 hastaya (16 sol, 11 sağ HS-MTLE) cerrahi oncesi video EEG, kranial manyetik rezonans görüntüleme, Wada testi ile ameliyat öncesi ve sonrası birinci yılda Weschler görsel subtest ve sözel bellek süreçleri testleri uygulanmıştır. Bulgular: Wada bellek testinde sol hemisfer dominant bulunanlarn sayısı 6 (%22.2), atipik yerleşimli olanların sayısı 21 (%77.8) idi. Bellek dominansı sol ve atipik olanlarda nöbet başlama yaşı (p=0.042), ve HS (sağ/sol) tarafı açısından karşılaştırıldığında da anlamlı fark saptanmıştır (p=0.002). Yine sol bellek dominant olanlar ile ameliyat öncesi ve sonrası verbal ve nonverbal testler arasındaki korelasyona bakıldığında sö-zel bellek süreçleri testlerinden 'gecikmeli hatırlama' puanları arasında...

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“…On the other hand, recurrent seizures might also result in deterioration of both verbal and spatial memory functions over time. Some reports show improvement in both verbal and spatial memory functions following SAH (1,24). Despite the risk of morbidity and mortality of surgery, epileptic seizures themselves have a higher risk, and surgical treatment has favorable and costeffective results in comparison with AEDs (25).…”

Section: Discussionmentioning

confidence: 99%

“…Whereas 90% of patients are diagnosed in developing countries, 40 to 70 per 100 million people are annually diagnosed in developed countries (1). Currently, surgical treatment has an important place in the management of epilepsy in accordance with the technical improvements in modern medicine, which leads to patients' quality of life improving (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Surgery for intractable temporal lobe epilepsy: experience of a single institution

Kurt¹,

Tönge²,

Çeltikçi³

et al. 2014

Turk J Med Sci

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Background/aim: In the treatment of epilepsy, encouraging results have been achieved with surgical treatment, especially for temporal lobe epilepsy (TLE). Drug resistance must be diagnosed as early as possible, because the ensuing seizures can be eliminated surgically via temporal lobe surgery in a high percentage (70%-90%) of patients. In this study we share our experience, in a single institution, of surgical treatment of intractable TLE. Materials and methods:Between March 2006 and November 2010 we performed 127 corticoamygdalohippocampectomy (CAH) procedures. All CAH surgical procedures were done as described by Niemeyer's technique. Resection lengths were 4-4.5 cm from the temporal pole.Results: At the end of 24 months, 79.7% (n = 94) patients were still on antiepileptic medications, with 55 of them on a decreased number or dose of drugs, and 20.3 (n = 24) patients were antiepileptic drug-free. Postoperative Engel's classes were 1, 2, and 3 in 87.2%, 5.08%, and 7.6%, respectively. There was no mortality in follow-up, and dysphasia in 1 patient (0.84%) was the only morbidity. Conclusion:In our series we found that the outcome of surgery is associated with careful patient selection, which requires a detailed investigation of the patients. Our final conclusion is that outcome scores are independent of age, pathology, or sex but are dependent on correct patient selection.

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Memory outcome following transsylvian selective amygdalohippocampectomy in 62 patients with hippocampal sclerosis

Cited by 37 publications

References 33 publications

Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes

Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes

Relationship between the Wada test and preoperative/postoperative memory in mesial temporal lobe epilepsy patients

Surgery for intractable temporal lobe epilepsy: experience of a single institution

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