Comparisons of the seizure-free outcome and visual field deficits between anterior temporal lobectomy and selective amygdalohippocampectomy: A systematic review and meta-analysis

Abstract

The purpose of our study is to compare seizure-free outcome and the incidence of visual field deficits (VFD) between anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH) among patients with intractable temporal lobe epilepsy (TLE). Methods: We searched MEDLINE, Embase and Cochrane databases using keywords related to ATL, SAH and VFD. Previous studies that compared ATL and SAH with seizure-free outcome and the incidence of VFD were included. A fixed-effect model was used to conduct meta-analysis. Risk ratio with 95% confidence intervals were pooled and used to elucidate each outcome. Results: Twenty-three retrospective and three prospective studies were recruited with a total of 2930 cases (1390 cases for SAH and 1540 cases for ATL). The meta-analysis showed no significant difference in seizure freedom (SAH 63.5% vs ATL 63.8%) of these two procedures (RR 0.95, 95%CI 0.90-1.01, P = 0.102), but the odds of seizure freedom in ATL was higher than transsylvian SAH approach (RR 0.89 95% CI 0.82-0.96, P = 0.004). Comparing with ATL for TLE, SAH for TLE caused lower frequency of postoperative VFD. (RR 0.87, 95%CI 0.76-0.99, P = 0.034). Conclusions: There was no significant difference on seizure freedom between ATL and SAH procedures, while subgroup analysis demonstrated that ATL was associated with higher opportunity to achieve seizure-free than transsylvian SAH approach. Furthermore, the incidence of postoperative VFD was significantly lower in SAH than ATL. Individualized treatment achieving balance between seizure free and collateral damage should be considered in clinical practice. Well-designed randomized controlled clinical trials would be necessary to validate our findings.

Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis of outcomes

“…For this reason, the search strategy for ATL and sAHE was adapted so that only randomized controlled trials (RCTs) and (retrospective/prospective) comparative studies between ATL and sAHE were included. The comparative studies were extracted from two recent high‐quality comprehensive systematic reviews 15,16 . Among the various classifications established for the outcome after epilepsy surgery or intervention, the Engel Epilepsy Surgery Outcome Scale was used most frequently among the studies examined so that only studies that included this classification were selected for the final analysis 17…”

“…The comparative studies were extracted from two recent high-quality comprehensive systematic reviews. 15,16 Among the various classifications established for the outcome after epilepsy surgery or intervention, the Engel Epilepsy Surgery Outcome Scale was used most frequently among the studies examined so that only studies that included this classification were selected for the final analysis. 17 Eligible studies were required to meet the following criteria: In cases where a study was a follow-up to or an expansion of an already published cohort, the paper reporting on the more detailed and comprehensive dataset was included.…”

Visual outcomes after anterior temporal lobectomy and transsylvian selective amygdalohippocampectomy: A quantitative comparison of clinical and diffusion data

“…Furthermore, there is a lack of consensus concerning the visual outcomes of SAHE and ATL. Although Xu et al showed a lower incidence of VFDs following SAHE, 14 their recommendation is based on a small number of studies. Especially single‐center studies directly comparing surgical techniques are scarce.…”

Visual field defects in temporal lobe epilepsy surgery

“…This improves to 73% when surgical intervention is undertaken within 2 years of the onset of disabling seizures 2 . As the benefit of surgical resections for drug-refractory mesial temporal lobe epilepsy became more apparent an increasing number of patients became seizure-free but were not eligible for a driving licence due to the magnitude of the resulting VFD 3 . In many countries, VFDs along the horizontal meridian within an area subtending 120 degrees or a significant defect within the central +/-20 degrees during binocular Esterman protocol assessment would preclude eligibility for a driving licence.…”