Treatment of Temporal-Lobe Epilepsy by Temporal Lobectomy a Survey of Findings and Results

Falconer, Murray A.; Hill, Dave; Meyer, Alfred; Mitchell, William F.; Pond, D. A.; Hoare, R. D.; Pampiglione, G.

doi:10.1016/s0140-6736(55)90421-9

Cited by 190 publications

(73 citation statements)

References 26 publications

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“…Feindel, studying Penfield's material, had also demonstrated the paramount role played by the amygdala in the temporal lobe automatisms and seizures. 6,7 The standard procedure for temporal resection used in most centres had been an "en bloc" resection, advocated among others by M. Falconer 38 and later by Polkey in England 54 and Crandall 55 in the United States. At the MNI, the standard technique has been that of an anterior temporal resection including the amygdala and the anterior hippocampus (Figure 11).…”

Section: Discussionmentioning

confidence: 99%

“…Atrophic changes and volumetric assessments of these changes for specific structures can now be documented accurately with MRI. 36 The syndrome of mesio-temporal lobe epilepsy has been reviewed recently by Wieser et al 37 The role of febrile convulsions in the pathogenesis of temporal epilepsy was stressed by Falconer 38 and more recently by Abou-Kalil 39 and Berkovic. 36 It is fair to say that the clinical manifestations of mesio-temporal epilepsy are, in large part, the same as those characteristics of "temporal lobe epilepsy", namely the presence of an aura, most often a hard to describe sensation, the alteration of consciousness with oral and manual automatisms, followed by amnesia for the episode.…”

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confidence: 99%

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Transcortical Selective Amygdalohippocampectomy in Temporal Lobe Epilepsy

Olivier

2000

Can J Neurol Sci.

137

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Suppl. 1 -S68Insight in the role played by the mesio-temporal structures in human epilepsy is derived from various sources. Hughlings Jackson 1 was the first to describe the autopsy findings showing a mesio-temporal lesion as the cause of psychomotor seizures. Echoing the original observations of Jackson, the many experimental studies of the 1950s such as those of Kaada, 2 Vigouroux, 3 Gastaut, 4 Green, 5 and the observations in the human by Feindel,6,7 Penfield and Jasper, 8 and Morris 9 pointed to a very important role of the mesiobasal temporal structures in experimental and human epilepsies.There is a large collection of data describing striking neuropathological changes in the mesio-temporal area in patients with temporal epilepsy. The hippocampal sclerosis and mesiotemporal sclerosis, including changes in the amygdala, were reviewed in detail in a series of excellent studies. [10][11][12] More recent work has shed light on the basic physiopathological mechanisms responsible for mesio-temporal epilepsy. [13][14][15][16][17][18][19][20] Studies on mesio-temporal kindling have brought further ABSTRACT: Numerous studies of the electrophysiology and neuropathology of temporal lobe epilepsy have demonstrated the mesial temporal structures to be the site of seizure origin in the majority of cases. This is the rationale for a transcortical selective approach, first introduced by Niemeyer, for removal of the hippocampus and amygdala. Series from a number of centers have demonstrated the efficacy of selective amygdalohippocampectomy compared to a more traditional resection. The technique described here and used at the Montreal Neurological Institute (MNI) utilizes a strictly endopial resection of the hippocampal formation and amygdala in addition to computer image guidance to perform the procedure. Ninety-five percent of patients at the MNI who underwent selective amygdalohippocampectomy realized a cessation of seizures, or greater than 90% reduction, with minimal risk of complications.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Transcortical Selective Amygdalohippocampectomy in Temporal Lobe Epilepsy

Olivier

2000

Can J Neurol Sci.

137

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“…1,4, 14,15,20,32,36,41 However, these approaches have some risk of damaging neocortical structures and white matter pathways or involve an extremely narrow operating field, excessive brain retraction, and potential injury to the vein of Labbé. The transsylvian approach was proposed to reduce these risks.…”

Section: 45mentioning

confidence: 99%

Microsurgical anatomy of the inferior limiting insular sulcus and the temporal stem

Ribas

Yağmurlu

Wen

et al. 2015

JNS

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T he temporal stem is a widely used term, but is still a controversial concept. Definitions of the stem range from its being as small as the fiber bundles passing between the limen insula and the anterior end of the temporal horn, to its being as large as including all the fibers passing beneath the length of the inferior limiting insular sulcus (ILS). 13,42,45,46 The transsylvian approach to the medial temporal lobe is commonly directed through or adjacent to the ILS and temporal stem, where opening of the temporal horn and exposure of the amygdala and the hippocampus are key steps. Unfortunately, the temporal lobe is the site of important brain functions, and complications involving visual and language deficits are not rare. 12,34,38 In this study, based on the larger definition of the stem, the location of each white matter pathway between the ILS and temporal horn was described, with special attention to their relation to the limen insula. The meeting point of the ILS with the limen insula can be identified during surgery and used as a landmark to estimate the position of each set of fibers beneath the ILS. MethodsFourteen adult cadaveric cerebral hemispheres were examined using ×3 to ×40 magnification. The specimens were fixed with formalin and preserved in a 70% alcohol abbreviatioNs DTI = diffusion tensor imaging; ILS = inferior limiting insular sulcus; LGB = lateral geniculate body; TLP = temporal limen point. obJect The purpose of this study was to describe the location of each white matter pathway in the area between the inferior limiting insular sulcus (ILS) and temporal horn that may be crossed in approaches through the temporal stem to the medial temporal lobe. Methods The fiber tracts in 14 adult cadaveric cerebral hemispheres were examined using the Klingler technique. The fiber dissections were completed in a stepwise manner, identifying each white matter pathway in different planes and describing its position in relation to the anterior end of the ILS. results The short-association fibers from the extreme capsule, which continue toward the operculae, are the most superficial subcortical layer deep to the ILS. The external capsule fibers are found deeper at an intermediate layer and are formed by the uncinate fasciculus, inferior frontooccipital fasciculus, and claustrocortical fibers in a sequential anteroposterior disposition. The anterior commissure forms the next deeper layer, and the optic radiations in the sublenticular part of the internal capsule represent the deepest layer. The uncinate fasciculus is found deep to the anterior third of the ILS, whereas the inferior frontooccipital fasciculus and optic radiations are found superficial and deep, respectively, at the posterior two-thirds of this length. coNclusioNs The authors' findings suggest that in the transsylvian approach, a 6-mm incision beginning just posterior to the limen insula through the ILS will cross the uncinate fasciculus but not the inferior frontooccipital fasciculus or optic radiations, but that longer incisions carry a...

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“…Studies scoring working ability; economic, social, and personality aspects; rehabilitation; and comparable parameters have been conducted for many years in ES (75)(76)(77)(78)(79). Generally, the recent employment data described short-range results, but extrapolations can be made from available long-range outcomes (1 1).…”

Section: Employmentmentioning

confidence: 99%

Cost and Cost‐Effectiveness of Epilepsy Surgery

Silfvenius

1999

Epilepsia

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EPIDEMIOLOGYEpilepsy surgery (ES) should be considered when adequate antiepileptic drug (AED) therapy has failed. Any program planning for ES against intractable epilepsy should rely on the epidemiology of intractable partial/ secondarily generalized epilepsy. A recent survey concludes that remission is obtainable in 70-80% of newly diagnosed epilepsy patients (i.e., a 5515% higher remission rate compared with the earlier data), and 20% of children with epilepsy will continue to have seizures (1,2). One to two thirds of those with symptomatic partial seizures carry risk of drug resistance. The reported median prevalence of active epilepsy from adult populations largely medically untreated was 7.7/1,000; for the treated, 5.8/1,000 (3). A study on the natural history of epilepsy and its psychosocial outcome showed that 24% of the interviewed had monthly seizures, and 10-24% had psychosocial problems (4). A remission of 5 years in 68% of cases has been reported. In a specialized epilepsy center, 2-5% of the patients were said to be ES candidates, and 7-18% of epilepsy patients followed up by neurologists were estimated to be candidates (5,6). The epidemiology for palliative ES is less precise. A 55-60% risk of drug resistance in children with secondary generalized seizures is reported (2). Epidemiology is the basis for health economical estimations of epilepsy and its treatment (7). In this survey, aspects of the illness and the cost of ES are addressed. ES is a rather expensive high-technologic care, but not using it is even more costly to the community. PROGNOSIS AND SEIZURE INTRACTABILITYA number of negative prognostic factors have been identified in epilepsy, which include organic brain lesion, seizure onset in infancy, partial seizures, high seizure frequency, and multiple seizure types (1). In particular, seizures associated with mesial temporal atrophy/ sclerosis should be identified, as a few years' drug resistance should suffice for ES candidacy. Even today, Address correspondence and reprint requests to Dr. H. Silfvenius at Department of Neurosurgery, Section of Epilepsy, University Hospital, Umel S-90185, Sweden. the operated-on patients commonly have had decades of seizures before ES. Experience indicates that a considerable number of patients thought to have intractable epilepsy also can benefit from a comprehensive medical reevaluation (8,9). Severe epilepsy in children constitutes an urgent need for surgical evaluation (10). Quantified scoring has been proposed for intractability (1 1). It would facilitate input-outcome comparison and be useful in detailing ES failures. Secondary negative consequences of seizures in coping with life, health-related quality of life (QOL), employability, and economic situation of the patient are common expressions of illness intractability (12-15). PRESURGICAL INVESTIGATIONThe cost and cost-effectiveness of ES are related to the diagnostic armamentarium, surgical facilities, and results. Today, invasive video-EEG, electrocorticography, pre-and peroperative functional c...

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Treatment of Temporal-Lobe Epilepsy by Temporal Lobectomy a Survey of Findings and Results

Cited by 190 publications

References 26 publications

Transcortical Selective Amygdalohippocampectomy in Temporal Lobe Epilepsy

Transcortical Selective Amygdalohippocampectomy in Temporal Lobe Epilepsy

Microsurgical anatomy of the inferior limiting insular sulcus and the temporal stem

Cost and Cost‐Effectiveness of Epilepsy Surgery

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