Transsylvian amygdalohippocampectomy for mesial temporal lobe epilepsy: Comparison of three different approaches.
Adult
Amygdala
/ surgery
Anterior Temporal Lobectomy
Cerebral Cortex
Diffusion Tensor Imaging
Drug Resistant Epilepsy
/ surgery
Epilepsy, Temporal Lobe
/ surgery
Female
Hippocampus
/ pathology
Humans
Intelligence Tests
Male
Memory
Middle Aged
Neurosurgical Procedures
/ methods
Parahippocampal Gyrus
Postoperative Cognitive Complications
/ epidemiology
Prospective Studies
Sclerosis
Temporal Lobe
Treatment Outcome
Visual Fields
amygdalohippocampectomy
hippocampal sclerosis
temporal lobe epilepsy
temporal stem
tractography
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
16
07
2020
revised:
22
12
2020
accepted:
23
12
2020
pubmed:
16
1
2021
medline:
20
4
2021
entrez:
15
1
2021
Statut:
ppublish
Résumé
This study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline. We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI-AH, TU-AH, or TP-AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre- and postoperative memory performance and intelligence quotient (IQ). There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow-up with TP-AH (69.5%) and TI-AH (76.7%) as compared to the TU-AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto-occipital fasciculus postoperatively was reduced in the TI-AH group compared with the TU-AH and TP-AH groups (p = .001). The rate of visual field defects was significantly higher with TI-AH (14/19, 74%) in comparison to the TU-AH (5/15, 33%) and TP-AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left-sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP-AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right- and left-sided surgeries. The TP-AH group had better short-term seizure control than TU-AH, a lower rate of visual field defects than TI-AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP-AH is a better surgical approach for temporal lobe epilepsy with HS than TI-AH and TU-AH.
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
439-449Subventions
Organisme : Fundação de Amparo à Pesquisa do Estado de São Paulo
ID : 2013/07559-3
Informations de copyright
© 2021 International League Against Epilepsy.
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