Surgical Treatment of Mesiotemporal Lobe Epilepsy: Which Approach is Favorable?

Author:

Schmeiser Barbara1,Wagner Kathrin2,Schulze-Bonhage Andreas2,Mader Irina3,Wendling Anne-Sophie4,Steinhoff Bernhard Jochen4,Prinz Marco5,Scheiwe Christian1,Weyerbrock Astrid1,Zentner Josef1

Affiliation:

1. Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany

2. Department of Epileptology, University Hospital Freiburg, Freiburg, Germany

3. Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany

4. Epilepsy Center Kork, Kehl-Kork, Freiburg, Germany

5. Institute of Neuropathology, University Hospital Freiburg, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany

Abstract

Abstract BACKGROUND Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used. OBJECTIVE To analyze epileptological and neuropsychological results as well as complications of different surgical strategies. METHODS This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures. RESULTS Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome. CONCLUSION Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference92 articles.

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2. Multimodal approaches in the evaluation of epilepsy patients for surgery;Engel;Electroencephalogr Clin Neurophysiol Suppl,1999

3. Early identification of refractory epilepsy;Kwan;N Engl J Med,2000

4. Predictors of epilepsy surgery outcome: a meta-analysis;Tonini;Epilepsy Res,2004

5. Long-term seizure outcome of surgery versus no surgery for drug-resistant partial epilepsy: a review of controlled studies;Schmidt;Epilepsia,2009

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