Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

Abstract

Object. Whether selective amygdalohippocampectomy (SelAH) has similar seizure outcomes and better neuropsychological outcomes compared with anterior temporal lobectomy (ATL) is a matter of debate. The aim of this study was to compare the 2 types of surgery with respect to seizure outcomes and changes in IQ scores.Methods. PubMed, Embase, and the Cochrane Library were searched for relevant studies published between January 1990 and September 2012. Studies comparing SelAH and ATL with respect to seizure and intelligence outcomes were included. Two reviewers assessed the quality of the included studies and independently extracted the data. Odds ratios and standardized mean deviations with 95% confidence intervals were used to compare pooled proportions of freedom from seizures and changes in IQ scores between the SelAH and ATL groups.Results. Three prospective and 10 retrospective studies were identified involving 745 and 766 patients who underwent SelAH and ATL, respectively. The meta-analysis demonstrated a statistically significant reduction in the odds of seizure freedom for patients who underwent SelAH compared with those who underwent ATL (OR 0.65 [95% CI 0.51-0.82], p = 0.0005). The differences between the changes in all IQ scores after the 2 types of surgery were not statistically significant, regardless of the side of resection.Conclusions. Selective amygdalohippocampectomy statistically reduced the odds of being seizure free compared with ATL, but the clinical significance of this reduction needs to be further validated by well-designed randomized trials. Selective amygdalohippocampectomy did not have better outcomes than ATL with respect to intelligence. (http://thejns.org/doi/abs/10.3171/2013.8.JNS121854) Key WorDs • temporal lobe epilepsy • anterior temporal lobectomy • selective amygdalohippocampectomy • meta-analysis 1089Abbreviations used in this paper: ATL = anterior temporal lobectomy; FCD = focal cortical dysplasia; FIQ = full-scale IQ; HS = hippocampal sclerosis; MTLE = mesial temporal lobe epilepsy; NTLE = neocortical temporal lobe epilepsy; PIQ = performance IQ; SelAH = selective amygdalohippocampectomy; SMD = standardized mean deviation; VIQ = verbal IQ.See the corresponding editorial in this issue, pp 1087-1088.

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

“…Nonetheless, three studies have found better seizure-control in patients submitted to ATL 4,22,23 . Similarly, two recent systematic reviews concluded that ATL is associated with a reduced rate of seizure recurrence compared to SelAH 24,25 . In other words, a consensus on this matter has not yet been reached.…”

“…Numerous studies concluded that there are no differences between the two approaches, including the systematic review conducted by Hu et al 16,25,26 . Nevertheless, many other studies claim that SelAH confers lower cognitive morbidity, mostly involving language and verbal memory.…”

Surgical strategies for pediatric epilepsy

“…Two large meta-analyses of studies comparing the two procedures head to head found higher rates of seizure freedom after ATL than after SAH (52,53). One study found no significant difference in intelligence quotient scores between patients receiving the two procedures, and one was unable to make significant conclusions regarding differences in neuropsychiatric outcomes between the two groups.…”

Interrupção das fibras brancas nos acessos cirúrgicos ao corno temporal do ventrículo lateral: estudo anatômico

“…A maior parte das discussões relativa aos acessos cirúrgicos ao CTVL é centrada no tratamento cirúrgico da esclerose hipocampal, a forma mais comum de epilepsia resistente ao uso de medicações observada nos centros de cirurgia de epilepsia, respondendo por 17% a 31% dos procedimentos cirúrgicos realizados para o tratamento de epilepsia (Pasquier et al,2002;Piao et al, 2010, Hu et al,2013.…”

“…2005;Hu et al,2013), as controvérsias tem se concentrado na necessidade de se incisar, ressecar ou retrair o lobo temporal durante os procedimentos cirúrgicos (Penfield, 1954;Falconer;Wilson, 1958;Niemeyer, 1958;Marino;Rasmussen, 1968;Niemeyer;Bello, 1973;Weiser;Yasargil, 1982;Spencer et al,1984;Yasargil et al, 1985;Pasquier et al,2002;Piao et al, 2010;Hu et al,2013). Tais controvérsias tem norteado o desenvolvimento de acessos cirúrgicos não só para o tratamento das crises epilépticas, mas também para as lesões neoplásicas (Yasargil, 1994(Yasargil, , 1996(Yasargil, , 2005Yasargil et al, , 2010Smith et al, 1995;Ture et al, 2004Ture et al, , 2012de Oliveira et al, 2012) e vasculares (Heros, 1982;Ikeda et al, 2002;Yasargil, 1994Yasargil, , 1996Yasargil, , 2005Yasargil et al, , 2010Abla et al,2011;Ture et al;de Oliveira et al, 2012) que podem incidir nesta região.…”