Selective amygdalohippocampectomy versus standard temporal lobectomy in patients with mesial temporal lobe epilepsy and unilateral hippocampal sclerosis

Wendling, Anne‐Sophie; Hirsch, Édouard; Wisniewski, Ilona; Davanture, Céline; Ofer, Isabell; Zentner, Josef; Bilic, Sofia; Scholly, Julia; Staack, Anke M.; Valenti, Maria-Paula; Schulze‐Bonhage, Andreas; Kehrli, P.; Steinhoff, Bernhard J.

doi:10.1016/j.eplepsyres.2012.09.007

Cited by 75 publications

(60 citation statements)

References 58 publications

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“…It is believed that restricted resections are superior with respect to neuropsychological outcome and their seizure outcome is the same [35]. Along these lines of reasoning, limited ablations should be preferred over more generous approaches [36].…”

Section: Discussionmentioning

confidence: 99%

Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study

Krámská¹,

Vojtěch²,

Lukavský³

et al. 2017

Stereotact Funct Neurosurg

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Purpose: To assess the neuropsychological performance recoded over a period of 5 years after stereotactic radiofrequency amygdalohippocampectomy (SAHE) in the treatment of mesial temporal lobe epilepsy. Material and Methods: Thirty patients (mean age 38 years, 14 females/16 males) were included in this study. Twenty-one patients were treated on the left side, 9 on the right. Patients underwent neuropsychological evaluation by the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised preoperatively and 5 years after SAHE. Results: Twenty-three (77%) patients were classified as Engel class I. At the group level, we found significant increases in all intelligence domains (Global, Visual, and Performance) by 19.1 (7.4), 15.8 (6.1), and 19.1 (7.9) points, respectively. Significant improvements were also detected in all memory measures (Global, Verbal, Visual, Attention/Concentration, Delayed Recall) by 19.4 (14.2), 16.9 (13.3), 19.0 (14.7), 15.3 (15.0), and 24.6 (13.4), respectively. Patients with left-sided surgery improved significantly more in Attention/Concentration. Otherwise, there were no statistically significant differences in memory function improvements between subgroups according to the operated side. Conclusion: After SAHE, we found favorable long-term neuropsychological outcomes. These results could be caused by incomplete destruction of target structures and minimization of collateral damage that possibly enables adaptive postoperative neuronal reorganization.

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Section: Discussionmentioning

confidence: 99%

Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study

Krámská¹,

Vojtěch²,

Lukavský³

et al. 2017

Stereotact Funct Neurosurg

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“…It has been described by most major series that postoperative seizure control does not differ significantly between the two approaches 7,13,14,15,16,17,18,19,20,21 . Nonetheless, three studies have found better seizure-control in patients submitted to ATL 4,22,23 .…”

Section: Discussionmentioning

confidence: 99%

“…Quite a few studies have tried to identify the best surgical technique to treat patients with TLE, few of them, however, included patients with unilateral MTS as the sole underlying pathology 13,14,15 . With this goal, we carefully selected a series of patients diagnosed with unilateral MTS who were operated by one of our two attending neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

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

Nascimento

Gatto

Silvado

et al. 2015

Arq. Neuro-Psiquiatr.

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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.

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“…The selection of operative approaches for hippocampal lesions in treating epilepsy has been controversial. Previous studies have found that for patients with secondary temporal epilepsy from only hippocampal sclerosis, there was no significant difference in the clinical remission rate of epilepsy between the patients receiving the selective resection of the hippocampus and amygdala and the patients receiving the standard resection of anterotemporal medial structures (1, 3,10,11,13,14). Two surgical methods were adopted in this study: 27 patients underwent the simple resection of lesions and the surrounding invaded tissue, and 29 patients underwent standard resection of the anterior temporal lobe, lesions and their surrounding invaded tissue as well as the medial structures of the temporal lobe.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Microsurgical outcomes of secondary epilepsy from hippocampal lesions: a report of 56 cases and literature review

Wang¹,

Xing²,

Ma³

et al. 2014

Turkish Neurosurgery

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ABSTRACToperative methods in the treatment of secondary epilepsy from hippocampal lesions. █ MATERIAl and METhODS Selection of PatientsThere were 56 patients enrolled in this study including 31 males and 25 females. These patients were aged 16 to 74 years (mean age, 35.1±13.5 years) and had a history of epilepsy from 2 months to 10 years (mean length, 17.2±13.1 months). The inclusion criteria for patients diagnosed as having hippocampal sclerosis was that systematic anti- █ InTRODuCTIOnMesial temporal lobe epilepsy (MTLE) is the most common type of temporal lobe epilepsy in the clinic, and it tends to develop into medically intractable epilepsy. Hippocampal lesions are the most common cause of MTLE. Currently, the treatment strategy of this epilepsy type remains clinically controversial (16). In this paper, we retrospectively analyzed the clinical data and the outcomes of the microsurgical treatment of 56 patients who had secondary epilepsy from hippocampal lesions and were treated during the period from January 2005 to January 2014. The purpose of this study was to explore the significance of microsurgery and its various AIM: To explore the treatment efficacy of microsurgery for secondary epilepsy from hippocampal lesions. MATERIAl and METhODS:The clinical data, pathological findings, surgical methods and surgical outcomes of 56 patients with secondary epilepsy from hippocampal lesions were retrospectively analyzed. RESulTS:Postoperative pathological examinations confirmed that 27 patients had gliomas, 17 patients had vascular malformations and 12 patients had hippocampal sclerosis. Twenty-nine patients underwent selective resection of the lesioned tissue and the surrounding infiltrated tissue, and 26 patients underwent a more generous removal of the anterior temporal lobe, lesioned tissue, infiltrated tissue and medial structures of the temporal lobe. Fifty patients were followed up with an average follow-up duration of 25.5 months. At postoperative one year, the remission rate of epilepsy that achieved Engel grade I was 80.8% (21/26) and 83.3% (20/24) for the selective resection and more generous resection, respectively, indicating that the difference between the two methods was insignificant.COnCluSIOn: Microsurgery is the first choice for the treatment of secondary epilepsy from hippocampal lesions. Various operative routes and methods can be selected based on the lesion natures. Long-term favorable outcome of seizure control following microsurgery can be achieved in most of the patients.

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Selective amygdalohippocampectomy versus standard temporal lobectomy in patients with mesial temporal lobe epilepsy and unilateral hippocampal sclerosis

Cited by 75 publications

References 58 publications

Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study

Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study

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

Microsurgical outcomes of secondary epilepsy from hippocampal lesions: a report of 56 cases and literature review

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