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

Palmini, André; Portuguez, Mirna Wetters; Paglioli, Eliseu; Azambuja, Ney; Costa, Jaderson Costa da; Filho, Hélio Fernandes da Silva; Martinez, José Victor; Hoeffel, João Rubião

doi:10.3171/jns.2006.104.1.70

Cited by 160 publications

(117 citation statements)

References 42 publications

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“…Nevertheless, many other studies claim that SelAH confers lower cognitive morbidity, mostly involving language and verbal memory. In fact, many of these studies agree that ATL is particularly cognitively harmful when performed on the dominant hemisphere 6,7,23,27,28,29 -an observation that was also noted in our series.…”

Section: Discussionsupporting

confidence: 69%

“…It has been described by most major series that postoperative seizure control does not differ significantly between the two approaches 7,13,14,15,16,17,18,19,20,21 . Nonetheless, three studies have found better seizure-control in patients submitted to ATL 4,22,23 .…”

Section: Discussionmentioning

confidence: 99%

“…The latter is the most used worldwide -and also at our service -, due to lower operative risks. The rationale behind choosing the SelAH remains on the fact that the main origin of epileptogenic activity lies on the mesial portion of the temporal lobe; therefore, additional resection of superficial cortex would not influence on seizure control 7 . Moreover, this technique, for sparing the temporal neocortex, in theory results in less postoperative cognition deficits (including memory, language, and behaviour) (Figures 3, 4, and 5).…”

Section: Operative Techniques (Atl and Selah)mentioning

confidence: 99%

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Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Nascimento

Gatto

Silvado

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Operative Techniques (Atl and Selah)mentioning

confidence: 99%

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Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Nascimento

Gatto

Silvado

et al. 2015

Arq. Neuro-Psiquiatr.

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“…However, the surgical approach has not been found to be predictive of outcome. 9,36,46 The incidence of failure was 8.9% (61/686; Table 1). Hardy et al 16 and Hennessy et al 17 did not use the Engel classification but documented a failure rate (similar to Engel Class III/IV) of 7.6% and 12%, respectively.…”

Section: Resultsmentioning

confidence: 99%

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Vale¹,

Pollock²,

Benbadis

2012

FOC

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Object The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis. Methods A systematic review of the literature was performed for the years 1999–2010 to assess the cause of failure and to identify potential reoperation candidates. Results Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings. Conclusions The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.

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“…On the other hand, recurrent seizures might also result in deterioration of both verbal and spatial memory functions over time. Some reports show improvement in both verbal and spatial memory functions following SAH (1,24). Despite the risk of morbidity and mortality of surgery, epileptic seizures themselves have a higher risk, and surgical treatment has favorable and costeffective results in comparison with AEDs (25).…”

Section: Discussionmentioning

confidence: 99%

Surgery for intractable temporal lobe epilepsy: experience of a single institution

Kurt¹,

Tönge²,

Çeltikçi³

et al. 2014

Turk J Med Sci

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Background/aim: In the treatment of epilepsy, encouraging results have been achieved with surgical treatment, especially for temporal lobe epilepsy (TLE). Drug resistance must be diagnosed as early as possible, because the ensuing seizures can be eliminated surgically via temporal lobe surgery in a high percentage (70%-90%) of patients. In this study we share our experience, in a single institution, of surgical treatment of intractable TLE. Materials and methods:Between March 2006 and November 2010 we performed 127 corticoamygdalohippocampectomy (CAH) procedures. All CAH surgical procedures were done as described by Niemeyer's technique. Resection lengths were 4-4.5 cm from the temporal pole.Results: At the end of 24 months, 79.7% (n = 94) patients were still on antiepileptic medications, with 55 of them on a decreased number or dose of drugs, and 20.3 (n = 24) patients were antiepileptic drug-free. Postoperative Engel's classes were 1, 2, and 3 in 87.2%, 5.08%, and 7.6%, respectively. There was no mortality in follow-up, and dysphasia in 1 patient (0.84%) was the only morbidity. Conclusion:In our series we found that the outcome of surgery is associated with careful patient selection, which requires a detailed investigation of the patients. Our final conclusion is that outcome scores are independent of age, pathology, or sex but are dependent on correct patient selection.

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

Abstract: 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.

Cited by 160 publications

References 42 publications

Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Surgery for intractable temporal lobe epilepsy: experience of a single institution

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