ABSTRACT
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.
temporal lobe epilepsy; amygdalo-hippocampal epilepsy; anterior temporal lobectomy; neuropsychological tests; seizures; postoperative complications
T1-weighted coronal MRI; resection is demarcated with gray-colored line. ATL: anterior temporal lobectomy; H: hippocampus; PH: parahippocampal gyrus; T1, T2 e T3: superior, middle, and inferior temporal gyri; SF: Sylvian fissure.
T1-weighted coronal MRI; grey arrow targets the site of status-post right ATL. T2, T3, hippocampus, and parahippocampal gyrus were resected; amygdala was partially removed. ATL: anterior temporal lobectomy.
T1-weighted coronal MRI. The black line corresponds to the corridor of dissection (with a 3 cm incision) through T2 to the mesial structures. SelAH: selective amygdalohippocampectomy; WM: white matter; H: hippocampus; PH: parahippocampal gyrus. T1, T2 e T3: superior, middle, and inferior temporal gyri; SF: Sylvian fissure.
(A) Final surgical cavity, after resection and hemostasis. (B) View after suture of the cortical incision. SelAH: selective amygdalohippocampectomy; SF: Sylvian fissure; LV: Labbé vein.
T1-weighted coronal MRI. MRI coronal T1 sequence. Black arrow targets the site of status-post right SelAH, mesial structures were appropriately resected; SelAH: selective amygdalohippocampectomy; H: hippocampus; PH: parahippocampal gyrus.