scholarly journals Neuropsychological performance and seizure control after subsequent anteromesial temporal lobe resection following selective amygdalohippocampectomy

Epilepsia ◽  
2016 ◽  
Vol 57 (11) ◽  
pp. 1789-1797 ◽  
Author(s):  
Thomas Sauvigny ◽  
Katja Brückner ◽  
Lasse Dührsen ◽  
Oliver Heese ◽  
Manfred Westphal ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Seizure Control ◽  
Neuropsychological Performance ◽  
Selective Amygdalohippocampectomy ◽  
Temporal Lobe Resection

Volumetric brain analysis in neurosurgery: Part 3. Volumetric CT analysis as a predictor of seizure outcome following temporal lobectomy

2015 ◽  
Vol 15 (2) ◽  
pp. 133-143 ◽  
Author(s):  
Jason G. Mandell ◽  
Kenneth L. Hill ◽  
Dan T. D. Nguyen ◽  
Kevin W. Moser ◽  
Robert E. Harbaugh ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Seizure Control ◽  
Brain Volume ◽  
Structural Mri ◽  
Seizure Outcome ◽  
Brain Volumes ◽  
Temporal Lobe Resection ◽  
Ct Analysis ◽  
Volumetric Ct ◽  
Class Ib

OBJECT The incidence of temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS) can be high in developing countries. Current diagnosis of MTS relies on structural MRI, which is generally unavailable in developing world settings. Given widespread effects on temporal lobe structure beyond hippocampal atrophy in TLE, the authors propose that CT volumetric analysis can be used in patient selection to help predict outcomes following resection. METHODS Ten pediatric patients received preoperative CT scans and temporal resections at the CURE Children's Hospital of Uganda. Engel classification of seizure control was determined 12 months postoperatively. Temporal lobe volumes were measured from CT and from normative MR images using the Cavalieri method. Whole brain and fluid volumes were measured using particle filter segmentation. Linear discrimination analysis (LDA) was used to classify seizure outcome by temporal lobe volumes and normalized brain volume. RESULTS Epilepsy patients showed normal to small brain volumes and small temporal lobes bilaterally. A multivariate measure of the volume of each temporal lobe separated patients who were seizure free (Engel Class IA) from those with incomplete seizure control (Engel Class IB/IIB) with LDA (p < 0.01). Temporal lobe volumes also separate normal subjects, patients with Engel Class IA outcomes, and patients with Class IB/IIB outcomes (p < 0.01). Additionally, the authors demonstrated that age-normalized whole brain volume, in combination with temporal lobe volumes, may further improve outcome prediction (p < 0.01). CONCLUSIONS This study shows strong evidence that temporal lobe and brain volume can be predictive of seizure outcome following temporal lobe resection, and that volumetric CT analysis of the temporal lobe may be feasible in lieu of structural MRI when the latter is unavailable. Furthermore, since the authors' methods are modality independent, these findings suggest that temporal lobe and normative brain volumes may further be useful in the selection of patients for temporal lobe resection when structural MRI is available.

Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis

2006 ◽  
Vol 104 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Eliseu Paglioli ◽  
André Palmini ◽  
Mirna Portuguez ◽  
Eduardo Paglioli ◽  
Ney Azambuja ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Seizure Control ◽  
Hippocampal Sclerosis ◽  
Surgical Techniques ◽  
Mesial Temporal Lobe Epilepsy ◽  
Outcome Data ◽  
Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy

Object The aim of this study was to compare seizure and memory outcome in patients with medically refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) treated using an anterior temporal lobectomy (ATL) or a selective amygdalohippocampectomy (SA). Methods Surgical outcome data were prospectively collected for 2 to 11 years in 161 consecutive patients with MTLE/HS. Eighty patients underwent an ATL and 81 an SA. Seizure control achieved with each technique was compared using the Engel classification scheme. Postoperative memory testing was performed in 86 patients (53%). At the last follow up, 72% of the patients who had undergone an ATL (mean follow up 6.7 years) and 71% of those who had undergone an SA (mean follow up 4.5 years) were seizure free (Engle Class IA). Estimated survival in patients in Engel Classes I, IA, and I and II combined did not differ between the two surgical techniques. Preoperatively, 58% of the patients had verbal memory scores one standard deviation (SD) below the normal mean. One third of the patients with preoperative scores in the normal range worsened after surgery, although this outcome was not related to the surgical technique. In contrast, one third of those whose preoperative scores were less than −1 SD experienced improvement after surgery. Nine (18%) of the 50 patients whose left side had been surgically treated improved their verbal memory scores by more than one SD. Seven (78%) of these nine underwent an SA (p = 0.05). Conclusions Both ATL and SA can lead to similar favorable seizure control in patients with MTLE/HS. Preliminary data suggest that postoperative verbal memory scores may improve in patients who undergo selective resection of a sclerotic hippocampus in the dominant temporal lobe.

Selective amygdalohippocampectomy via the transsylvian approach

2008 ◽  
Vol 25 (3) ◽  
pp. E5 ◽  
Author(s):  
Badih Adada
Keyword(s):  
Visual Field ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Neuropsychological Outcome ◽  
Transsylvian Approach ◽  
Selective Amygdalohippocampectomy ◽  
Established Treatment

Surgery is an established treatment for temporal lobe epilepsy refractory to medication. Several surgical approaches have been used to treat this condition including temporal lobectomy, transcortical selective amygdalohippocampectomy, subtemporal amygdalohippocampectomy, and transsylvian amygdalohippocampectomy. In this article the author reviews the transsylvian amygdalohyppocampectomy and pertinent anatomy. He also discusses the procedure's results with regard to seizure control, neuropsychological outcome, and visual field preservation.

Transparahippocampal selective amygdalohippocampectomy in children and adolescents: efficacy of the procedure and cognitive morbidity in patients

2000 ◽  
Vol 93 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Shenandoah Robinson ◽  
T. S. Park ◽  
Lynn B. Blackburn ◽  
Blaise F. D. Bourgeois ◽  
Susan T. Arnold ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Content Type ◽  
Clinical Variables ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference ◽  
Temporal Lobe Seizures ◽  
Mesial Temporal Lobe ◽  
Fine Print

Object. Unilateral resection of the hippocampus and amygdala can be used to treat medically intractable mesial temporal lobe seizures. To date seizure outcome and the extent of cognitive morbidity have been unknown in children following the transparahippocampal variation of selective amygdalohippocampectomy (TSA), which prompted the present prospective study.Methods. Preoperative examinations and outcomes in 22 consecutive children and adolescents who underwent TSA were studied. Cognitive and psychological morbidity were assessed using standard neuropsychological instruments. The authors evaluated relationships between seizure control and cognitive morbidity and 13 and nine clinical variables, respectively.Seizure control was achieved in 11 (65%) of 17 patients (> 2 years follow up). Among 13 clinical variables, the only preoperative finding that had a significant bearing on seizure control was the presence of unilateral hypometabolism, which could be observed on [18F]fluorodeoxyglucose—positron emission tomography scans (p < 0.001). Patients with seizure control showed significant improvements in verbal and full scale intelligence quotients (both p = 0.05). Patients with longer preoperative durations of seizures exhibited more cognitive impairment that persisted postoperatively. Cognitive outcome analysis based on nine clinical factors revealed no significant difference in cognitive parameters postoperatively, except that significant improvement occurred in rote verbal memory scores among patients who underwent right-sided TSA (p = 0.01). Individually, 81% of the children achieved significant improvement in at least one of seven cognitive parameters, and 52% had stable or improved scores in all parameters.Conclusions. The results indicate that TSA is a safe effective approach for the treatment of medically intractable mesial temporal lobe seizures in children with minimum effect on cognitive morbidity. Given that the literature suggests that children suffer progressive cognitive morbidity from persistent seizures, the results of this study support early surgical intervention for this group of children.

Failure of temporal lobe resection for epilepsy in patients with mesial temporal sclerosis: results and treatment options

2009 ◽  
Vol 110 (6) ◽  
pp. 1127-1134 ◽  
Author(s):  
Edwin Ramos ◽  
Selim Benbadis ◽  
Fernando L. Vale
Keyword(s):  
Temporal Lobe ◽  
Seizure Control ◽  
Treatment Algorithm ◽  
Class I ◽  
Mesial Temporal Sclerosis ◽  
Incomplete Resection ◽  
Class Iii ◽  
Repeat Surgery ◽  
Initial Surgery ◽  
Temporal Lobe Resection

Object The purpose of this study was to identify the causes of failed temporal lobe resection in patients with mesial temporal sclerosis (MTS) and the role of repeat surgery for seizure control. Methods This is a retrospective study of 105 patients who underwent temporal lobe resection for MTS with unilateral electroencephalographic findings. The mean follow-up duration was 36 months (range 24–84 months). Surgeries were all performed by the senior author (F.L.V.). Results Following initial surgical intervention, 97 patients (92%) improved to Engel Class I or II (Group A), and 8 (8%) did not have significant improvement (Engel Class III or IV; Group B). These 8 patients were restudied using video-electroencephalography (EEG) and MR imaging. All major surgical failures occurred within 1 year after initial intervention. Reevaluation demonstrated 3 patients (37.5%) with contralateral temporal EEG findings. Five patients (62.5%) had evidence of ipsilateral recurrent discharges. Four patients underwent extended neocortical resection along the previous resection cavity. Their outcomes ranged from Engel Class I to Class III. Only 1 patient (12.5%) who failed to improve after initial surgery was found to have incomplete resection of mesial structures. This last patient underwent reoperation to complete the resection and improved to Engel Class I. Conclusions Failure of temporal lobe resection for MTS is multifactorial. The cause of failure lies in the pathological substrate of the epileptogenic area. Complete seizure control cannot be predicted solely by conventional preoperative workup. Initial surgical failures from temporal lobe resection often benefit from reevaluation, because reoperation may be beneficial in selected patients. Based on this work, the authors have proposed a management and treatment algorithm for these patients.

scholarly journals Resective, Ablative and Radiosurgical Interventions for Drug Resistant Mesial Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Outcomes

2021 ◽  
Vol 12 ◽  
Author(s):  
Kajol Marathe ◽  
Ali Alim-Marvasti ◽  
Karan Dahele ◽  
Fenglai Xiao ◽  
Sarah Buck ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Meta Analysis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Selective Amygdalohippocampectomy ◽  
Temporal Lobe Resection ◽  
Mesial Temporal Lobe

Objectives: One-third of individuals with focal epilepsy do not achieve seizure freedom despite best medical therapy. Mesial temporal lobe epilepsy (MTLE) is the most common form of drug resistant focal epilepsy. Surgery may lead to long-term seizure remission if the epileptogenic zone can be defined and safely removed or disconnected. We compare published outcomes following open surgical techniques, radiosurgery (SRS), laser interstitial thermal therapy (LITT) and radiofrequency ablation (RF-TC).Methods: PRISMA systematic review was performed through structured searches of PubMed, Embase and Cochrane databases. Inclusion criteria encompassed studies of MTLE reporting seizure-free outcomes in ≥10 patients with ≥12 months follow-up. Due to variability in open surgical approaches, only comparative studies were included to minimize the risk of bias. Random effects meta-analysis was performed to calculate effects sizes and a pooled estimate of the probability of seizure freedom per person-year. A mixed effects linear regression model was performed to compare effect sizes between interventions.Results: From 1,801 screened articles, 41 articles were included in the quantitative analysis. Open surgery included anterior temporal lobe resection as well as transcortical and trans-sylvian selective amygdalohippocampectomy. The pooled seizure-free rate per person-year was 0.72 (95% CI 0.66–0.79) with trans-sylvian selective amygdalohippocampectomy, 0.59 (95% CI 0.53–0.65) with LITT, 0.70 (95% CI 0.64–0.77) with anterior temporal lobe resection, 0.60 (95% CI 0.49–0.73) with transcortical selective amygdalohippocampectomy, 0.38 (95% CI 0.14–1.00) with RF-TC and 0.50 (95% CI 0.34–0.73) with SRS. Follow up duration and study sizes were limited with LITT and RF-TC. A mixed-effects linear regression model suggests significant differences between interventions, with LITT, ATLR and SAH demonstrating the largest effects estimates and RF-TC the lowest.Conclusions: Overall, novel “minimally invasive” approaches are still comparatively less efficacious than open surgery. LITT shows promising seizure effectiveness, however follow-up durations are shorter for minimally invasive approaches so the durability of the outcomes cannot yet be assessed. Secondary outcome measures such as Neurological complications, neuropsychological outcome and interventional morbidity are poorly reported but are important considerations when deciding on first-line treatments.

scholarly journals Surgical treatment of Temporal Lobe Epilepsy: comparative results of selective amygdalohippocampectomy versus anterior temporal lobectomy from a referral center in Brazil

2021 ◽  
Author(s):  
Laryssa C Azevedo Almeida ◽  
Vanessa Alves Lobato ◽  
Maria do Carmo Vasconcelos Santos ◽  
Aline Curcio de Moraes ◽  
Bruno Silva Costa
Keyword(s):  
Data Analysis ◽  
Surgical Technique ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Belo Horizonte

Abstract IntroductionTemporal Lobe Epilepsy (TLE) is a high prevalence neurological disorder and tends to drug refractoriness. Surgery has emerged as a promising treatment for managing crises and a better quality of life for these patients. The objective of this work is to compare the surgical results in terms of seizures control concerning the surgical technique performed (Anterior temporal lobectomy (ATL) vs. Selective amygdalohippocampectomy (SAH)) in a cohort of 132 patients operated in an epilepsy reference center.Materials and methodsWe performed a retrospective study based on the review of medical records of 146 patients operated for TLE from 2008 to 2019 at the Santa Casa de Misericordia in Belo Horizonte, Brazil. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. We used the ILAE (International League Against Epilepsy) scale to classify seizure control after surgery. We compared the surgical groups using the survival and Kaplan-Maier curves.ResultsA total of 132 patients were evaluated in this study, with a mean follow-up time after surgery of 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57,1% vs. 31%) and a higher rate of satisfactory seizure control (88,6% vs. 69,3%) p =0.006.ConclusionThe literature is still controversial about seizure control results concerning the surgical technique used due to the lack of studies with a robust methodology for an adequate comparison. In our data analysis, we identified the superiority of ATL over SAH in seizure outcomes.

Long-term seizure outcome after mesial temporal lobe epilepsy surgery: corticalamygdalohippocampectomy versus selective amygdalohippocampectomy

2008 ◽  
Vol 108 (3) ◽  
pp. 517-524 ◽  
Author(s):  
Taner Tanriverdi ◽  
Andre Olivier ◽  
Nicole Poulin ◽  
Frederick Andermann ◽  
François Dubeau
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Selective Amygdalohippocampectomy ◽  
Selective Approach ◽  
Significant Difference ◽  
The Impact

Object Resection strategies for the treatment of temporal lobe epilepsy (TLE) are a matter of discussion, and little information is available. The aim of this study was to compare seizure outcomes at the 5-year follow-up in patients with medically refractory unilateral mesial TLE (MTLE) due to hippocampal sclerosis (HS) who were treated using a cortical amygdalohippocampectomy (CorAH) or a selective AH (SelAH). Methods The authors obtained data from 100 adult patients who underwent surgery for MTLE. Fifty patients underwent a CorAH and 50 underwent an SelAH. Seizure control achieved with each technique was compared using the Engel classification scheme. Results Overall, at the 5-year follow-up, favorable (Engel Classes I and II) seizure outcomes were noted in 82 and 90% of patients who had undergone CorAH and SelAH, respectively. Furthermore, 40% of the patients who had undergone a CorAH and 58% of those who had undergone an SelAH were seizure free (Engel Class Ia). There was no statistically significant difference between the 2 surgical approaches in terms of seizure outcome at the 5-year follow-up (p = 0.38). Conclusions Both CorAH and SelAH can lead to similar favorable seizure control in patients with MTLE/HS. However, the authors suggest that the transcortical selective approach has the great advantage of minimizing or completely abolishing the impact of dividing several venous and arterial adhesions which are tedious, time consuming, and, at times, associated with some degree of cerebral swelling.

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