Subtemporal Multiple Hippocampal Transection with/without CA1-Subiculum Disconnection for Medically Intractable Temporal Lobe Epilepsy

Abstract

Transsylvian selective amygdalohippocampectomy resulted in postoperative verbal memory decline in patients with mesial temporal lobe epilepsy of the language-dominant side. Mapping whole-brain connectivity changes have been studied recently of different surgical resection approaches for temporal lobe epilepsy. The subtemporal resection is the least disruptive to long-range connectivity, which may explain its better cognitive outcome. Finally, the authors introduced subtemporal multiple hippocampal transections technique in a case of hippocampal sclerosis negative left mesial temporal lobe epilepsy, and postoperative neuropsychological examinations revealed improvement of cognitive function immediately after the operation contrasting transsylvian multiple hippocampal transections in which verbal memory remains dropped. The authors introduced another new operation to left mesial temporal lobe epilepsy patient with hippocampal sclerosis by multiple hippocampal transections plus disconnection between CA1 and subiculum at the hippocampal head. Operative result is satisfactory in terms of neuropsychological and operative outcome.