Long-term seizure outcome after mesial temporal lobe epilepsy surgery: corticalamygdalohippocampectomy versus selective amygdalohippocampectomy

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Object

Resection strategies for the treatment of temporal lobe epilepsy (TLE) are a matter of discussion, and little information is available. The aim of this study was to compare seizure outcomes at the 5-year follow-up in patients with medically refractory unilateral mesial TLE (MTLE) due to hippocampal sclerosis (HS) who were treated using a cortical amygdalohippocampectomy (CorAH) or a selective AH (SelAH).

Methods

The authors obtained data from 100 adult patients who underwent surgery for MTLE. Fifty patients underwent a CorAH and 50 underwent an SelAH. Seizure control achieved with each technique was compared using the Engel classification scheme.

Results

Overall, at the 5-year follow-up, favorable (Engel Classes I and II) seizure outcomes were noted in 82 and 90% of patients who had undergone CorAH and SelAH, respectively. Furthermore, 40% of the patients who had undergone a CorAH and 58% of those who had undergone an SelAH were seizure free (Engel Class Ia). There was no statistically significant difference between the 2 surgical approaches in terms of seizure outcome at the 5-year follow-up (p = 0.38).

Conclusions

Both CorAH and SelAH can lead to similar favorable seizure control in patients with MTLE/HS. However, the authors suggest that the transcortical selective approach has the great advantage of minimizing or completely abolishing the impact of dividing several venous and arterial adhesions which are tedious, time consuming, and, at times, associated with some degree of cerebral swelling.

Abbreviations used in this paper: AH = amygdalohippocampectomy; CorAH = cortical AH; ECoG = electrocorticography; EEG = electroencephalography; HS = hippocampal sclerosis; MNI = Montreal Neurological Institute; MR = magnetic resonance; MTLE = mesial temporal lobe epilepsy; SD = standard deviation; SelAH = selective AH.

Article Information

Address correspondence to: Taner Tanriverdi, M.D., Department of Neurosurgery, Montreal Neurological Institute and Hospital, 3801 University Avenue, Suite 109, Montreal, Quebec H3A 2B4, Canada. email: tanerato2000@yahoo.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph showing overall seizure outcome in 100 patients at the 5-year follow-up according to Engel classification. CAH = CorAH; SAH = SelAH.

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    Bar graph showing the percentage of patients who are seizure free without aura (Engel Class Ia). Note that the percentages decrease each year following surgery.

  • View in gallery

    Bar graph showing seizure outcome in patients who underwent CorAH and SelAH at the 5-year follow-up. No statistically significant difference was found between the 2 surgical techniques.

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