Selective versus non-selective temporal lobe surgery for epilepsy

MacKenzie, Ross; Matheson, J. M.; Ellis, Mark; Klamus, J

doi:10.1016/s0967-5868(97)90064-3

Cited by 34 publications

(31 citation statements)

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“…Second, as Schramm mentioned, the distinction between MTLE and neocortical temporal lobe epilepsy was not often made in older papers, 33 which might lead to a result favoring ATL. Although only 3 relatively older studies were included in the present meta-analysis, 13,21,30 this limitation should be taken into account. Finally, previous studies discussed memory decline after SelAH or ATL; 11,36 it is necessary to analyze the differences between the 2 procedures with respect to postoperative memory decline.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, some investigators have recorded neocortical epileptiform spikes with cortical electrodes, 1,35 indicating that tailored resection of the temporal neocortex is Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies essential for MTLE. Other studies have suggested that better seizure outcomes were achieved in patients who underwent ATL than in those who underwent SelAH, 3,21 and that no significant differences in neuropsychological outcomes were found between the surgical strategies. 12,42 A review attempted to pool studies comparing ATL and SelAH for MTLE to test the hypothesis that the latter procedure produces similar seizure and favorable neuropsychological outcomes, and the conclusion was concordant with the hypothesis.…”

Section: ©Aans 2013mentioning

confidence: 91%

“…Figure 5 shows a funnel plot of the studies included in the meta-analysis for seizure outcomes. All studies were located inside the 95% CI except the study by Mackenzie et al, 21 with a roughly symmetrical distribution around the OR (vertical line), indicating a mild publication bias.…”

Section: Sensitivity Analysis and Publication Biasmentioning

confidence: 91%

“…33 However, no meta-analysis of outcome differences between the surgical strategies has been performed. Since the studies comparing the procedures have conflicting results, 3,7,21,23,30,39 a meta-analysis of prior studies could help define the optimal treatment. The aim of the present systematic review and meta-analysis was to determine if SelAH is the superior approach and whether this method might lead to similar seizure and better neuropsychological outcomes than ATL for patients with MTLE.…”

Section: ©Aans 2013mentioning

confidence: 99%

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Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

Zhang

et al. 2013

JNS

132

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Object. Whether selective amygdalohippocampectomy (SelAH) has similar seizure outcomes and better neuropsychological outcomes compared with anterior temporal lobectomy (ATL) is a matter of debate. The aim of this study was to compare the 2 types of surgery with respect to seizure outcomes and changes in IQ scores.Methods. PubMed, Embase, and the Cochrane Library were searched for relevant studies published between January 1990 and September 2012. Studies comparing SelAH and ATL with respect to seizure and intelligence outcomes were included. Two reviewers assessed the quality of the included studies and independently extracted the data. Odds ratios and standardized mean deviations with 95% confidence intervals were used to compare pooled proportions of freedom from seizures and changes in IQ scores between the SelAH and ATL groups.Results. Three prospective and 10 retrospective studies were identified involving 745 and 766 patients who underwent SelAH and ATL, respectively. The meta-analysis demonstrated a statistically significant reduction in the odds of seizure freedom for patients who underwent SelAH compared with those who underwent ATL (OR 0.65 [95% CI 0.51-0.82], p = 0.0005). The differences between the changes in all IQ scores after the 2 types of surgery were not statistically significant, regardless of the side of resection.Conclusions. Selective amygdalohippocampectomy statistically reduced the odds of being seizure free compared with ATL, but the clinical significance of this reduction needs to be further validated by well-designed randomized trials. Selective amygdalohippocampectomy did not have better outcomes than ATL with respect to intelligence. (http://thejns.org/doi/abs/10.3171/2013.8.JNS121854) Key WorDs • temporal lobe epilepsy • anterior temporal lobectomy • selective amygdalohippocampectomy • meta-analysis 1089Abbreviations used in this paper: ATL = anterior temporal lobectomy; FCD = focal cortical dysplasia; FIQ = full-scale IQ; HS = hippocampal sclerosis; MTLE = mesial temporal lobe epilepsy; NTLE = neocortical temporal lobe epilepsy; PIQ = performance IQ; SelAH = selective amygdalohippocampectomy; SMD = standardized mean deviation; VIQ = verbal IQ.See the corresponding editorial in this issue, pp 1087-1088.

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Section: Discussionmentioning

confidence: 99%

Section: ©Aans 2013mentioning

confidence: 91%

Section: Sensitivity Analysis and Publication Biasmentioning

confidence: 91%

Section: ©Aans 2013mentioning

confidence: 99%

See 2 more Smart Citations

Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

Zhang

et al. 2013

JNS

132

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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 . Similarly, two recent systematic reviews concluded that ATL is associated with a reduced rate of seizure recurrence compared to SelAH 24,25 .…”

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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Temporal Lobe Resections

Zentner¹

2020

Surgical Treatment of Epilepsies

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Selective versus non-selective temporal lobe surgery for epilepsy

Cited by 34 publications

References 5 publications

Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

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

Temporal Lobe Resections

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