Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

Object The purpose of this study was to identify the complications associated with the inferior temporal gyrus approach to anterior mesial temporal lobe resection for temporal lobe epilepsy. Methods This retrospective study examined complications experienced by 483 patients during the 3 months after surgery. All surgeries were performed during 1998–2012 by the senior author (F.L.V.). Results A total of 13 complications (2.7%) were reported. Complications were 8 delayed subdural hematomas (1.6%), 2 superficial wound infections (0.4%), 1 delayed intracranial hemorrhage (0.2%), 1 small lacunar stroke (0.2%), and 1 transient frontalis nerve palsy (0.2%). Three patients with subdural hematoma (0.6%) required readmission and surgical intervention. One patient (0.2%) with delayed intracranial hemorrhage required readmission to the neuroscience intensive care unit for observation. No deaths or severe neurological impairments were reported. Among the 8 patients with subdural hematoma, 7 were older than 40 years (87.5%); however, this finding was not statistically significant (p = 0.198). Conclusions The inferior temporal gyrus approach to mesial temporal lobe resection is a safe and effective method for treating temporal lobe epilepsy. Morbidity and mortality rates associated with this procedure are lower than those associated with other neurosurgical procedures. The finding that surgical complications seem to be more common among older patients emphasizes the need for early surgical referral of patients with medically refractory epilepsy.

Download Full-text

Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy

Neurosurgery ◽

10.1093/neuros/nyx302 ◽

2017 ◽

Vol 82 (6) ◽

pp. 833-841 ◽

Cited By ~ 6

Author(s):

Mike R Schoenberg ◽

William E Clifton ◽

Ryan W Sever ◽

Fernando L Vale

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Verbal Memory ◽

Visual Memory ◽

Mesial Temporal Lobe Epilepsy ◽

Significant Decline ◽

Mesial Temporal Sclerosis ◽

Wada Test ◽

Inferior Temporal Gyrus ◽

Mesial Temporal Lobe

Abstract BACKGROUND Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE) that are refractory to medical management. The inferior temporal gyrus (ITG) approach provides access to the mesial temporal lobe (MTL) structures with minimal tissue disruption. Reported neuropsychology outcomes following this approach are limited. OBJECTIVE To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospective design. METHODS Fifty-four participants had Engel class I/II outcome following resection of MTL using the ITG approach. All participants had localization-related epilepsy confirmed by long-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, and neuropsychology assessment. RESULTS Clinical semiology/video-electroencephalography indicated that of the 54 patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) had pathology-confirmed mesial temporal sclerosis (MTS). Group level analyses found declines in verbal memory for patients with language-dominant resections (P < .05). No significant decline in neuropsychological measures occurred for patients with MTS. Participants without MTS who underwent a language-dominant lobe resection exhibited a significant decline in verbal and visual memory (P < .05). Nondominant resection participants did not exhibit significant change in neuropsychology scores (P > .05). CONCLUSION Neuropsychology outcomes of an ITG approach for selective mesial temporal resection are comparable to other selective AH techniques showing minimal adverse cognitive effects. These data lend support to the ITG approach for selective AH as an option for MTLE.

Download Full-text

The Risk–Benefit Ratio for Temporal Lobe Resection in Patients with Bilateral Mesial Temporal Lobe Epilepsy

Epilepsy Currents ◽

10.5698/1535-7597-15.2.78 ◽

2015 ◽

Vol 15 (2) ◽

pp. 78-79 ◽

Cited By ~ 2

Author(s):

Lara E. Jehi

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Benefit Ratio ◽

Temporal Lobe Resection ◽

Mesial Temporal Lobe

Download Full-text

A Multicenter, Prospective Pilot Study of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy: Seizure Response, Adverse Events, and Verbal Memory

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(10)79267-x ◽

2010 ◽

Vol 2010 ◽

pp. 223-224

Author(s):

P.A. House

Keyword(s):

Pilot Study ◽

Adverse Events ◽

Temporal Lobe Epilepsy ◽

Gamma Knife ◽

Temporal Lobe ◽

Verbal Memory ◽

Gamma Knife Radiosurgery ◽

Mesial Temporal Lobe Epilepsy ◽

Prospective Pilot Study ◽

Mesial Temporal Lobe

Download Full-text

Voxel-based morphometry (VBM) in unilateral mesial temporal lobe epilepsy (mTLE): Volume loss beyond the seizure onset zone and neuropsychological implications

Aktuelle Neurologie ◽

10.1055/s-2007-987716 ◽

2007 ◽

Vol 34 (S 2) ◽

Author(s):

N Embacher ◽

C Brenneis ◽

I Unterberger ◽

J Dobesberger ◽

G Walser ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Volume Loss ◽

Voxel Based Morphometry ◽

Seizure Onset ◽

Seizure Onset Zone ◽

Mesial Temporal Lobe

Download Full-text

Faculty Opinions recommendation of Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736604573.793566615 ◽

2019 ◽

Author(s):

John Paul Leach

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Radiofrequency Thermocoagulation ◽

Mesial Temporal Lobe

Download Full-text

Faculty Opinions recommendation of How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.7709956.8030054 ◽

2011 ◽

Author(s):

Selim Benbadis

Keyword(s):

Temporal Lobe Epilepsy ◽

Antiepileptic Drugs ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Mesial Temporal Lobe

Download Full-text

Diffusion Tensor Imaging Analysis with Tract-Based Spatial Statistics in Patients with Mesial Temporal Lobe Epilepsy

ACTA BIOPHYSICA SINICA ◽

10.3724/sp.j.1260.2012.20051 ◽

2012 ◽

Vol 28 (6) ◽

pp. 477

Author(s):

Chuanjian XU ◽

Ling TAO ◽

Guangming LU ◽

Zhiqiang ZHANG ◽

Yuan ZHONG ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Temporal Lobe Epilepsy ◽

Spatial Statistics ◽

Temporal Lobe ◽

Diffusion Tensor ◽

Mesial Temporal Lobe Epilepsy ◽

Imaging Analysis ◽

Mesial Temporal Lobe ◽

Tract Based Spatial Statistics

Download Full-text

Stereotactic EEG-guided radiofrequency thermocoagulation versus anterior temporal lobectomy for mesial temporal lobe epilepsy with hippocampal sclerosis: study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05378-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yi-He Wang ◽

Si-Chang Chen ◽

Peng-Hu Wei ◽

Kun Yang ◽

Xiao-Tong Fan ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Controlled Trial ◽

Mesial Temporal Lobe Epilepsy ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Radiofrequency Thermocoagulation ◽

Mesial Temporal Lobe ◽

Randomised Controlled

Abstract Introduction In this report, we aim to describe the design for the randomised controlled trial of Stereotactic electroencephalogram (EEG)-guided Radiofrequency Thermocoagulation versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (STARTS). Mesial temporal lobe epilepsy (mTLE) is a classical subtype of temporal lobe epilepsy that often requires surgical intervention. Although anterior temporal lobectomy (ATL) remains the most popular treatment for mTLE, accumulating evidence has indicated that ATL can cause tetartanopia and memory impairments. Stereotactic EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a non-invasive alternative associated with lower seizure freedom but greater preservation of neurological function. In the present study, we aim to compare the safety and efficacy of SEEG-guided RF-TC and classical ATL in the treatment of mTLE. Methods and analysis STARTS is a single-centre, two-arm, randomised controlled, parallel-group clinical trial. The study includes patients with typical mTLE over the age of 14 who have drug-resistant seizures for at least 2 years and have been determined via detailed evaluation to be surgical candidates prior to randomisation. The primary outcome measure is the cognitive function at the 1-year follow-up after treatment. Seizure outcomes, visual field abnormalities after surgery, quality of life, ancillary outcomes, and adverse events will also be evaluated at 1-year follow-up as secondary outcomes. Discussion SEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual field protection. This is the first RCT studying cognitive outcomes and treatment results between SEEG-guided RF-TC and standard ATL for mTLE with hippocampal sclerosis. This study may provide higher levels of clinical evidence for the treatment of mTLE. Trial registration ClinicalTrials.gov NCT03941613. Registered on May 8, 2019. The STARTS protocol has been registered on the US National Institutes of Health. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

Download Full-text