Seizure outcome in pediatric medically refractory temporal lobe epilepsy surgery: selective amygdalohippocampectomy versus anterior temporal lobectomy

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this study was to investigate long-term seizure outcome, rate of reoperation, and postoperative neuropsychological performance following selective amygdalohippocampectomy (SelAH) or anterior temporal lobectomy (ATL) in pediatric patients with medically refractory temporal lobe epilepsy (TLE).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective review of cases of medically refractory pediatric TLE treated initially with either SelAH or ATL. Standardized pre- and postoperative evaluation included seizure charting, surface and long-term video-electroencephalography, 1.5-T MRI, and neuropsychological testing.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 79 patients treated initially with SelAH (n = 18) or ATL (n = 61) were included in this study, with a mean follow-up of 5.3 ± 4 years (range 1–16 years). The patients’ average age at initial surgery was 10.6 ± 5 years, with an average surgical delay of 5.7 ± 4 years between seizure onset and surgery. Seizure freedom (Engel I) following the initial operation was significantly more likely following ATL (47/61, 77%) than SelAH (8/18, 44%; p = 0.017, Fisher’s exact test). There was no statistically significant difference in the proportion of patients with postoperative neuropsychological deficits following SelAH (8/18, 44%) or ATL (21/61, 34%). However, reoperation was significantly more likely following SelAH (8/18, 44%) than after ATL (7/61, 11%; p = 0.004) and was more likely to result in Engel I outcome for ATL after failed SelAH (7/8, 88%) than for posterior extension after failed ATL (1/7, 14%; p = 0.01). Reoperation was well tolerated without significant neuropsychological deterioration. Ultimately, including 15 reoperations, 58 of 79 (73%) patients were free from disabling seizures at the most recent follow-up.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>SelAH among pediatric patients with medically refractory unilateral TLE yields significantly worse rates of seizure control compared with ATL. Reoperation is significantly more likely following SelAH, is not associated with incremental neuropsychological deterioration, and frequently results in freedom from disabling seizures. These results are significant in that they argue against using SelAH for pediatric TLE surgery.</jats:p></jats:sec>

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

“…43 A nonsignificant tendency toward a worse visual memory outcome after ATL, especially after right-sided surgery, was reported by Tanriverdi et al and Morino et al 47,51 In contrast, a significant improvement in figural memory performance was found in four studies with a tendency towards left-sided surgery. 48,49,51,52 A decline in naming ability was reported by Engel et al in 55% (6/11) of patients after ATL. 37 In contrast, Sagher et al did not find significant changes in Boston Naming Test scores after either ATL or sAHE.…”

“…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.…”

“…Finally, 13 studies dealing with MRgLITT 21‐31 and six dealing with RFA 32‐36 were included (Figure 1). For ATL and sAHE, four RCTs 4,37‐39 and 20 comparative studies 40‐59 were included.…”

Transsylvian amygdalohippocampectomy for mesial temporal lobe epilepsy: Comparison of three different approaches

“…Favorable seizure outcome also positively influences the postoperative IQ, although the impact of seizure control is still controversial regarding memory tasks 5,39 . The manner in which the extent of the resection impacts neurocognitive performance following TLE surgery is also not clear, as there are studies reporting no differences between nonselective and selective approaches and no memory decline following nonselective resection in some subgroups of patients 5,40,41 . It is important to note that late postoperative structural MRIs showed prominent atrophy and increased T2‐weighted signal in the temporal pole after selective transsylvian amygdalohippocampectomies (TI‐AH and TU‐AH) 3,16 .…”

The Clinical Significance of miR-135b-5p and Its Role in the Proliferation and Apoptosis of Hippocampus Neurons in Children with Temporal Lobe Epilepsy

“…TLE is the most complex partial epilepsy syndrome which will eventually develop into intractable seizures as patients become resistant to treatment drugs [18]. TLE generally occurs in childhood and recurs many times throughout life, although some pediatric TLE patients do benefit from acceptable and safe resection [19,20]. TLE is accompanied by long-term language impairment, cog- nitive decline, and even memory deficits, all of which diminish the quality of social events and life [21][22][23].…”