Seizure Outcome following Transcortical Selective Amygdalohippocampectomy in Mesial Temporal Lobe Epilepsy

Acar, Göksemin; Acar, Feri̇dun; Miller, Jonathan P.; Spencer, David C.; Burchiel, Kim J.

doi:10.1159/000160154

Cited by 34 publications

(20 citation statements)

References 56 publications

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“…[1][2][3]5,7,[10][11][12]14,15,19,28,29,31,32,37,[46][47][48]50,52,56,57,63,64,66,73,74 Studies varied with inclusion of imaging-defined and/or pathologically diagnosed MTS, the type and timing of the seizure outcome analyses, and the definitions used for seizure freedom. Rates of seizure freedom decrease with longer follow-up.…”

Section: Seizure Freedom Over Time After Surgery For Mtsmentioning

confidence: 99%

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Elliott¹,

Bollo

Berliner³

et al. 2013

JNS

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Object In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH). Methods The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom. Results The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures. Conclusions Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.

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Section: Seizure Freedom Over Time After Surgery For Mtsmentioning

confidence: 99%

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Elliott¹,

Bollo

Berliner³

et al. 2013

JNS

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“…Though the trans-middle temporal gyrus approach was initially described in 1958, there have been only a limited number of modern clinical series that have assessed its clinical impact as measured by post-operative Engel classification, neuropsychological consequences and surgical complications 1,22,26 . Herein, we have evaluated the trans-middle temporal approach to evaluate seizure response rates, neuropsychological outcomes and complications for consideration as a safe and effective choice with regard to seizure control and functional outcome.…”

Section: Introductionmentioning

confidence: 99%

Trans-middle temporal gyrus selective amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy in adults: Seizure response rates, complications, and neuropsychological outcomes

Bandt¹,

Werner²,

Dines³

et al. 2013

Epilepsy & Behavior

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Objective The selective amygdalohippocampectomy (AHC) has evolved to encompass a variety of techniques to resect the mesial temporal lobe. To date, there have been few large-scale evaluations of the trans-middle temporal gyrus selective AHC. The authors examine a large series of patients who have undergone trans-middle temporal gyrus AHC and assess its clinical and neuropsychological impact. Methods A series of 76 adult patients underwent selective AHC via the trans-middle temporal gyrus approach over a 10 year period, 19 of whom underwent pre and post-operative neuropsychological evaluation. Results Favorable seizure response rates were achieved (92% Engel class I or II), with very low surgical morbidity and no mortality. Postoperative neuropsychological assessment revealed a decline in verbal memory for the left AHC group. No post-operative memory decline was identified for the right AHC group but rather some improvements were noted within this group. Conclusions The trans-middle temporal gyrus selective AHC is a safe and effective choice for management of adult medically refractory epilepsy.

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“…To be appropriate for wider adoption, however, it must confer some advantage over the risk-benefit profile of conventional approaches. The risks of traditional craniotomy approaches to the temporal lobe include neurological deficits, such as hemiparesis [16][17][18] , cranial nerve deficits [19,20] , and visual field loss [6,21] , and cognitive deficits, such as language and memory impairment [22,23] . Some of these complications can be attributed to the disruption of the lateral temporal cortex and white matter tracts.…”

Section: Discussionmentioning

confidence: 99%

Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience

Chen¹,

Bohman²,

Emery³

et al. 2015

ORL

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Background/Aims: Transorbital approaches traditionally have focused on skull base and cavernous sinus lesions medial to the globe. Lateral orbital approaches to the temporal lobe have not been widely explored despite several theoretical advantages compared to open craniotomy. Recently, we demonstrated the feasibility of the lateral transorbital technique in cadaveric specimens with endoscopic visualization. We describe our initial clinical experience with the endoscope-assisted lateral transorbital approach to lesions in the temporal lobe. Methods: Two patients with mesial temporal lobe pathology presenting with seizures underwent surgery. The use of a transpalpebral or Stallard-Wright eyebrow incision enabled access to the intraorbital compartment, and a lateral orbital wall 'keyhole' opening permitted visualization of the anterior temporal pole. Results: This approach afforded adequate access to the surgical target and surrounding structures and was well tolerated by the patients. To the best of our knowledge, this report constitutes the first case series describing the endoscope-assisted lateral transorbital approach to the temporal lobe. We discuss the limits of exposure, the nuances of opening and closing, and comparisons to open craniotomy. Conclusion: Further prospective investigation of this approach is warranted for comparison to traditional approaches to the mesial temporal lobe.

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Seizure Outcome following Transcortical Selective Amygdalohippocampectomy in Mesial Temporal Lobe Epilepsy

Cited by 34 publications

References 56 publications

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Trans-middle temporal gyrus selective amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy in adults: Seizure response rates, complications, and neuropsychological outcomes

Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience

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