Microsurgical techniques in temporal lobe epilepsy

Abstract

SUMMARYTemporal lobe resection is the most prevalent epilepsy surgery procedure. However, there is no consensus on the best surgical approach to treat temporal lobe epilepsy. Complication rates are low and efficacy is very high regarding seizures after such procedures. However, there is still ample controversy regarding the best surgical approach to warrant maximum seizure control with minimal functional deficits. We describe the most frequently used microsurgical techniques for removal of both the lateral and mesial temporal lobe structures in the treatment of medically intractable temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (corticoamygdalohippocampectomy and selective amygdalohippocampectomy). The choice of surgical technique appears to remain a surgeon's preference for the near future. Meticulous surgical technique and thorough three-dimensional microsurgical knowledge are essentials for obtaining the best results. KEY WORDS: Temporal lobe epilepsy, Surgery, Cortico-amygdalohippocampectomy, Selective amygdalohippocampectomy.Temporal lobe resection remains one of the most successful operations for the treatment of epilepsy.1 Different standardized surgical approaches were developed in which the temporal neocortex might be included or not in the resection. 2 The main modalities are corticoamygdalohippocampectomy (CAH; often referred to as anterior temporal lobectomy: ATL), and selective amygdalohippocampectomy (SAH). The selection of anatomic versus tailored resection, the relative resection of neocortical versus medial structures, the exact extent of resection of mesial structures, and the surgical approach often depend on the surgeon's preferences and training.3,4 Assessing the relative efficacy of each surgical technique is difficult, given the heterogeneity of reported series. Overall, patients are rarely considered candidates for SAH if the mesial temporal region looks normal on magnetic resonance imaging (MRI). Anterior temporal resection is also preferable when temporal neocortical features are noted. Mesial temporal sclerosis remains the main etiology for refractory temporal lobe epilepsy in patients who are submitted to surgery, although a decrease in the number of such cases over the years has been reported in the literature, particularly in more economically developed countries. An adequate explanation for this phenomenon has not yet been found, but might include overall better epilepsy/seizure care, as well as earlier surgical treatment of such patients. 5 We describe the most frequently used approaches and surgical techniques for removal of both the lateral and mesial temporal lobe structures in the treatment of

Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy

“…Current knowledge about the neurobiology of epilepsy in humans mainly emerges from autopsies, from surgical resections obtained from patients with pharmacoresistant TLE who underwent temporal lobectomy [ 22 ], or from living subjects using PET. In all cases, sampling bias due to the selection of subjects that may not be representative of the whole spectrum of TLE scenarios can create limitations for the study of TLE using human tissue.…”

“…Current knowledge about the neurobiology of epilepsy in humans mainly emerges from surgical resections from patients with pharmacoresistant TLE who underwent temporal lobectomy as the only therapeutic option available [ 22 ]. The resulting specimens represent a rare chance to study the composition of the epileptic tissue, specifically with regard to the quantification and functioning of both synapses and neurotransmitter receptors [ 23 ].…”

The Clinical Significance of miR-135b-5p and Its Role in the Proliferation and Apoptosis of Hippocampus Neurons in Children with Temporal Lobe Epilepsy

“…TLE is the most complex partial epilepsy syndrome which will eventually develop into intractable seizures as patients become resistant to treatment drugs [18]. TLE generally occurs in childhood and recurs many times throughout life, although some pediatric TLE patients do benefit from acceptable and safe resection [19, 20]. TLE is accompanied by long-term language impairment, cognitive decline, and even memory deficits, all of which diminish the quality of social events and life [21-23].…”

Urinary urge seizure semiology localization by intracranial monitoring

“…In contrast, medically intractable temporal lobe epilepsy due to mesial temporal sclerosis is common and microsurgical corticoamygdalohippocampectomy and selective amygdalohippocampectomy remain the most common epilepsy surgeries. 4 The relatively low rate of complications and high rate of success make surgical treatment in patients with micturition seizures localized to the temporal lobe a reasonable option. Figure 4.…”