Surgical treatment of Temporal Lobe Epilepsy: comparative results of selective amygdalohippocampectomy versus anterior temporal lobectomy from a referral center in Brazil

Abstract

IntroductionTemporal Lobe Epilepsy (TLE) is a high prevalence neurological disorder and tends to drug refractoriness. Surgery has emerged as a promising treatment for managing crises and a better quality of life for these patients. The objective of this work is to compare the surgical results in terms of seizures control concerning the surgical technique performed (Anterior temporal lobectomy (ATL) vs. Selective amygdalohippocampectomy (SAH)) in a cohort of 132 patients operated in an epilepsy reference center.Materials and methodsWe performed a retrospective study based on the review of medical records of 146 patients operated for TLE from 2008 to 2019 at the Santa Casa de Misericordia in Belo Horizonte, Brazil. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. We used the ILAE (International League Against Epilepsy) scale to classify seizure control after surgery. We compared the surgical groups using the survival and Kaplan-Maier curves.ResultsA total of 132 patients were evaluated in this study, with a mean follow-up time after surgery of 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57,1% vs. 31%) and a higher rate of satisfactory seizure control (88,6% vs. 69,3%) p =0.006.ConclusionThe literature is still controversial about seizure control results concerning the surgical technique used due to the lack of studies with a robust methodology for an adequate comparison. In our data analysis, we identified the superiority of ATL over SAH in seizure outcomes.

More versus less: the unresolved debate on the best surgical approach to temporal lobe epilepsy with hippocampal sclerosis

“…In this issue, Almeida and colleagues present their results in 132 patients with TLE/HS followed for a mean of approximately 5 years. 15 They compare the results in seizure control in the 70 that had an ATL in the right side with the 62 who had a selective procedure (SAH) in the left. The rationale for their approach is clever: because verbal memory plays a bigger role in mnemonic functions, they assumed that a selective approach in the dominant temporal lobe would reduce cognitive risks, while still supported by a significant body of literature showing similar effectiveness with ATL regarding seizure control.…”