Short-term neurocognitive outcomes following anterior temporal lobectomy

Lee, Philip S.; Pardini, Jamie E.; Hendrickson, Rick; DeStefino, Vincent J.; Popescu, Alexandra; Ghearing, Gena; Antony, Arun; Pan, Jullie W.; Bagić, Anto; Wagner, Danielle; Richardson, R. Mark

doi:10.1016/j.yebeh.2016.06.019

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…Class I evidence shows that anteromedial temporal lobectomy (ATL) is superior to medical management for mesial temporal lobe epilepsy (mTLE), with respect to seizure freedom and quality of life 2,3 . Major neurological complications in epilepsy surgery are rare, 4 but neuropsychological sequelae are more commonly reported, particularly after dominant hemisphere resection 5,6 …”

Section: Introductionmentioning

confidence: 99%

Effects of laser interstitial thermal therapy for mesial temporal lobe epilepsy on the structural connectome and its relationship to seizure freedom

et al. 2021

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Objective: Laser interstitial thermal therapy (LITT) is a minimally invasive surgery for mesial temporal lobe epilepsy (mTLE), but the effects of individual patient anatomy and location of ablation volumes affect seizure outcomes. The purpose of this study is to see if features of individual patient structural connectomes predict surgical outcomes after LITT for mTLE.Methods: This is a retrospective analysis of seizure outcomes of LITT for mTLE in 24 patients. We use preoperative diffusion tensor imaging (DTI) to simulate changes in structural connectivity after laser ablation. A two-step machinelearning algorithm is applied to predict seizure outcomes from the change in connectomic features after surgery.Results: Although node-based network features such as clustering coefficient and betweenness centrality have some predictive value, changes in connection strength between mesial temporal regions predict seizure outcomes significantly better. Changes in connection strength between the entorhinal cortex (EC), and the insula, hippocampus, and amygdala, as well as between the temporal pole and hippocampus, predict Engel Class I outcomes with an accuracy of 88%. Analysis of the ablation location, as well as simulated, alternative ablations, reveals that a more medial, anterior, and inferior ablation volume is associated with a greater effect on these connections, and potentially on seizure outcomes.Significance: Our results indicate (1) that seizure outcomes can be retrospectively predicted with excellent accuracy using changes in structural connectivity, and (2) that favorable connectomic changes are associated with an ablation volume involving relatively mesial, anterior, and inferior locations. These results may provide a framework whereby individual pre-operative structural connectomes can be used to optimize ablation volumes and improve outcomes in LITT for mTLE.

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Section: Introductionmentioning

confidence: 99%

Effects of laser interstitial thermal therapy for mesial temporal lobe epilepsy on the structural connectome and its relationship to seizure freedom

et al. 2021

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“…In this study, we evaluated the benefit of intracranial sEEG and SDE/DE investigations in achieving seizure control specifically in patients who ultimately underwent ATL, standardized by a single neurosurgeon's surgical approach. 31 Overall, the results of our retrospective study suggest that sEEG and SDE/DE implantation in refractory TLE epilepsy cases results in outcomes that are not inferior to those in patients whose presurgical data were concordant enough to allow ATL without prior intracranial investigation. These outcomes appear at least as favorable as those reported in a major prospective cohort study.…”

Section: Discussionmentioning

confidence: 52%

“…On the other hand, ATL is a well-established procedure with specific standardized anatomical boundaries. 31,35 ATL is established as the gold-standard treatment for drug-refractory TLE patients, where it has been shown to provide seizure freedom in approximately two-thirds of patients at one year and nearly half at 10 years. 15,36 Therefore, our rationale in using a cohort that underwent the same surgical treatment was to address the validity of prior intracranial investigations without introducing confounds related to the type of temporal lobe surgery or anatomical extent of the resection.…”

Section: Discussionmentioning

confidence: 99%

“…Standard en bloc resection was used to perform ATLs. 31 A temporal craniotomy was performed exposing the Sylvian fissure. In dominant hemisphere ATLs, the overall posterior neocortical extent of resection did not exceed 4.5 cm from the pole, modified up to 2 cm from the pole on the superior temporal gyrus and up to 3 cm on the middle temporal gyrus.…”

Section: Surgical Techniquesmentioning

confidence: 99%

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Intracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data

et al. 2021

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ObjectiveThe question of whether a patient with presumed temporal lobe seizures should proceed directly to temporal lobectomy surgery versus undergo intracranial monitoring arises commonly. We evaluate the effect of intracranial monitoring on seizure outcome in a retrospective cohort of consecutive subjects who specifically underwent an anterior temporal lobectomy (ATL) for refractory temporal lobe epilepsy (TLE).MethodsWe performed a retrospective analysis of 85 patients with focal refractory TLE who underwent ATL following: (a) intracranial monitoring via craniotomy and subdural/depth electrodes (SDE/DE), (b) intracranial monitoring via stereotactic electroencephalography (sEEG), or (c) no intracranial monitoring (direct ATL—dATL). For each subject, the presurgical primary hypothesis for epileptogenic zone localization was characterized as unilateral TLE, unilateral TLE plus (TLE+), or TLE with bilateral/poor lateralization.ResultsAt one‐year and most recent follow‐up, Engel Class I and combined I/II outcomes did not differ significantly between the groups. Outcomes were better in the dATL group compared to the intracranial monitoring groups for lesional cases but were similar in nonlesional cases. Those requiring intracranial monitoring for a hypothesis of TLE+had similar outcomes with either intracranial monitoring approach. sEEG was the only approach used in patients with bilateral or poorly lateralized TLE, resulting in 77.8% of patients seizure‐free at last follow‐up. Importantly, for 85% of patients undergoing SEEG, recommendation for ATL resulted from modifying the primary hypothesis based on iEEG data.SignificanceOur study highlights the value of intracranial monitoring in equalizing seizure outcomes in difficult‐to‐treat TLE patients undergoing ATL.

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“…Lesional imaging correlates with greater probability of seizure freedom but has poor correlation in patients needing intracranial EEG evaluation [4]. Neuropsychiatric deficits like word finding difficulty, memory loss, depression, psychoses are seen in patients and may worsen or improve after surgery [5].…”

Section: Introductionmentioning

confidence: 99%

To Stick or Not to Stick? Scalp and Intracranial EEG Evaluation Both Help Achieve Good Surgical and Neuropsychiatric Outcomes in Epilepsy Surgery up to 20 Years Post-Surgery

Swaminathan¹,

Davis²,

Litt³

et al. 2020

Journal of Experimental Neurology

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Background: Epilepsy surgery is excellent for treatment of refractory epilepsy. Scalp EEG and electrocorticography are used prior to epilepsy surgery with variable outcomes across different centers and techniques. Objectives:We analyzed outcomes following scalp & electrocorticography followed by resections at our center over 20 years. Methods:We reviewed charts from 142 patients with resections from 1996 -2015. Patients needed to have undergone resections and scalp and/or intracranial EEG with at least 2 years of follow-up. Outcomes were studied.Results: 64% of patients with resection after scalp EEG had Engel 1 outcomes. Temporal lobectomies were the majority of these and showed Engel 1 outcomes in 67% cases up to 20 years. Patients with electrocorticography had Engel 1 outcomes of 33%temporal onset, best at 45% Engel 1; frontal onset, worst at 50% Engel 4. 5% of patients with electrocorticography had prolonged implantation effects up to 7 years. Patients with scalp EEG only showed excellent concordance with lesional imaging, Engel 1 in 60-65% of patients. Mild neuropsychiatric deficits were noted in 35% of patients -36% of temporal and 47% of frontal patients without predominance of lateralization without the need for formal testing.Conclusions: Resection offers good long-term outcomes. Temporal onset predicts excellent outcomes with scalp EEG alone -Engel 1 & 2 jointly reach 80%. Lesional imaging predicted good outcomes in scalp EEG patients but not in those needing electrocorticography. Good electrocorticography overcomes absence of lesional imaging. Neuropsychiatric impairment is more probable with frontal onset and is usually mild.

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Short-term neurocognitive outcomes following anterior temporal lobectomy

Cited by 10 publications

References 25 publications

Effects of laser interstitial thermal therapy for mesial temporal lobe epilepsy on the structural connectome and its relationship to seizure freedom

Effects of laser interstitial thermal therapy for mesial temporal lobe epilepsy on the structural connectome and its relationship to seizure freedom

Intracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data

To Stick or Not to Stick? Scalp and Intracranial EEG Evaluation Both Help Achieve Good Surgical and Neuropsychiatric Outcomes in Epilepsy Surgery up to 20 Years Post-Surgery

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