Long-term seizure, cognitive, and psychiatric outcome following trans–middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy

Clinical article

Restricted access


Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities.


The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes.


The mean duration of follow-up for STL was 9.7 years (range 1–18 years), and for trans–middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1–15 years). There was no significant difference in seizure outcome when “favorable” was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when “favorable” was defined as time to loss of Engel Class IA status (p = 0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p = 0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p = 0.048).


Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.

Abbreviations used in this paper:AED = antiepileptic drug; ATN = anterior temporal neocortex; EEG = electroencephalography; MMPI-2 = Minnesota Multiphasic Personality Inventory-2; mtg-SelAH = trans–middle temporal gyrus SelAH; MTS = mesial temporal sclerosis; SelAH = selective amygdalohippocampectomy; STL = standard temporal lobectomy; TLE = temporal lobe epilepsy.

Article Information

Address correspondence to: Krzysztof A. Bujarski, M.D., Department of Neurology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756. email: Krzysztof.A.Bujarski@Dartmouth.edu.

Please include this information when citing this paper: published online April 26, 2013; DOI: 10.3171/2013.3.JNS12714.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Seizure outcome following STL and mtg-SelAH (mtg-SAH). A: Time to loss of Engel Class I or II status in years. B: Time to loss of Engel Class I status in years. C: Time to loss of Engel Class IA status in years. Numbers above the lines indicate the number of patients used for analysis at each time point.

  • View in gallery

    Individual changes on the MMPI-2 Paranoia Scale. A: Total scores in STL and mtg-SelAH between the pre- and postoperative time period. B: Change between pre- and postoperative time period in individual scores for STL. C: Change between pre- and postoperative time period in individual scores for mtg-SelAH. Data are arranged in order from lowest to highest change in score. Negative values indicate improvement. Side of resection is shown.



Bate HEldridge PVarma TWieshmann UC: The seizure outcome after amygdalohippocampectomy and temporal lobectomy. Eur J Neurol 14:90942007


Beck ATSteer RA: Manual for the Beck Depression Inventory San Antonio, TXThe Psychological Corporation1987


Bernhardt BCBernasconi NConcha LBernasconi A: Cortical thickness analysis in temporal lobe epilepsy: reproducibility and relation to outcome. Neurology 74:177617842010


Butcher JNDahlstrom WGGraham JRTellegen AMKaemmer B: The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for Administration and Scoring MinneapolisUniversity of Minnesota Press1989


Cacioppo JTBerntson GG: Social Neuroscience New YorkPsychology Press2005. 45


Casasanto DJKillgore WDMaldjian JAGlosser GAlsop DCCooke AM: Neural correlates of successful and unsuccessful verbal memory encoding. Brain Lang 80:2872952002


Cheung MCChan AS: Memory impairment in humans after bilateral damage to lateral temporal neocortex. Neuroreport 14:3713742003


Choi DNa DGByun HSSuh YLKim SERo DW: White-matter change in mesial temporal sclerosis: correlation of MRI with PET, pathology, and clinical features. Epilepsia 40:163416411999


Christodoulou CKoutroumanidis MHennessy MJElwes RDPolkey CEToone BK: Postictal psychosis after temporal lobectomy. Neurology 59:143214352002


Clusmann HSchramm JKral THelmstaedter COstertun BFimmers R: Prognostic factors and outcome after different types of resection for temporal lobe epilepsy. J Neurosurg 97:113111412002


Cohen-Gadol AAWilhelmi BGCollignon FWhite JBBritton JWCambier DM: Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. J Neurosurg 104:5135242006


de Tisi JBell GSPeacock JLMcEvoy AWHarkness WFSander JW: The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet 378:138813952011


Delis DCKramer JHKaplan EOber BA: California Verbal Learning Test ed 2San Antonio, TXThe Psychological Corporation2000


Dupont STanguy MLClemenceau SAdam CHazemann PBaulac M: Long-term prognosis and psychosocial outcomes after surgery for MTLE. Epilepsia 47:211521242006


Engel J Jr: Outcome with respect to epileptic seizures. Surgical Treatment of the Epilepsies New YorkRaven Press1987. 553571


Helmstaedter CElger CEHufnagel AZentner JSchramm J: Different effects of left anterior temporal lobectomy, selective amygdalohippocampectomy, temporal cortical lesionectomy on verbal learning, memory, and recognition. J Epilepsy 9:39451996


Helmstaedter CRichter SRöske SOltmanns FSchramm JLehmann TN: Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on material-specific memory in patients with mesial temporal lobe epilepsy. Epilepsia 49:88972008


Hori TTabuchi SKurosaki MKondo STakenobu AWatanabe T: Subtemporal amygdalohippocampectomy for treating medically intractable temporal lobe epilepsy. Neurosurgery 33:50571993


Kaplan EFGoodglass HWeintraub S: The Boston Naming Test PhiladelphiaLea and Febiger1983


Kim YDHeo KPark SCHuh KChang JWChoi JU: Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. Epilepsia 46:2512572005


Kirchhoff BAWagner ADMaril AStern CE: Prefrontal-temporal circuitry for episodic encoding and subsequent memory. J Neurosci 20:617361802000


Lee TMackenzie RAWalker AJMatheson JMSachdev P: Effects of left temporal lobectomy and amygdalohippocampectomy on memory. J Clin Neurosci 4:3143191997


Lowe AJDavid EKilpatrick CJMatkovic ZCook MJKaye A: Epilepsy surgery for pathologically proven hippocampal sclerosis provides long-term seizure control and improved quality of life. Epilepsia 45:2372422004


Mackenzie RAMatheson JEllis MKlamus J: Selective versus non-selective temporal lobe surgery for epilepsy. J Clin Neurosci 4:1521541997


Manchanda RMiller HMcLachlan RS: Post-ictal psychosis after right temporal lobectomy. J Neurol Neurosurg Psychiatry 56:2772791993


Margerison JHCorsellis JAN: Epilepsy and the temporal lobes. A clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular reference to the temporal lobes. Brain 89:4995301966


Mayanagi YWatanabe ENagahori YNankai M: Psychiatric and neuropsychological problems in epilepsy surgery: analysis of 100 cases that underwent surgery. Epilepsia 42:Suppl 619232001


Mesulam MM: Principles of Behavioral and Cognitive Neurology ed 2New YorkOxford University Press2000. 81


Morino MUda TNaito KYoshimura MIshibashi KGoto T: Comparison of neuropsychological outcomes after selective amygdalohippocampectomy versus anterior temporal lobectomy. Epilepsy Behav 9:951002006


Niemeyer PThe transventricular amygdala-hippocampectomy in the temporal lobe epilepsy. Baldwin MBailey P: The Temporal Lobe Epilepsy Springfield, ILCharles C Thomas1958. 461482


Ojemann GADodrill CB: Intraoperative techniques for reducing language and memory deficits with left temporal lobectomy. Adv Epileptol 16:3273301987


Olivier A: Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy. Can J Neurol Sci 27:Suppl 1S68S762000


Olson IRPlotzker AEzzyat Y: The enigmatic temporal pole: a review of findings on social and emotional processing. Brain 130:171817312007


Paglioli EPalmini APaglioli Eda Costa JCPortuguez MMartinez JV: Survival analysis of the surgical outcome of temporal lobe epilepsy due to hippocampal sclerosis. Epilepsia 45:138313912004


Paglioli EPalmini APortuguez MPaglioli EAzambuja Nda Costa JC: Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis. J Neurosurg 104:70782006


Rathore CPanda SSarma PSRadhakrishnan K: How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy?. Epilepsia 52:6276352011


Schmidt DBaumgartner CLöscher W: Seizure recurrence after planned discontinuation of antiepileptic drugs in seizure-free patients after epilepsy surgery: a review of current clinical experience. Epilepsia 45:1791862004


Seiam AHDhaliwal HWiebe S: Determinants of quality of life after epilepsy surgery: systematic review and evidence summary. Epilepsy Behav 21:4414452011


Shenton MEDickey CCFrumin MMcCarley RW: A review of MRI findings in schizophrenia. Schizophr Res 49:1522001


Spielberger CD: Manual for the State-Trait Anxiety Inventory: STAI (Form Y) Palo Alto, CAConsulting Psychologists Press1983


Tanriverdi TDudley RWRHasan AAl Jishi AAl Hinai QPoulin N: Memory outcome after temporal lobe epilepsy surgery: corticoamygdalohippocampectomy versus selective amygdalohippocampectomy. Clinical article. J Neurosurg 113:116411752010


Tanriverdi TOlivier APoulin NAndermann FDubeau F: Long-term seizure outcome after mesial temporal lobe epilepsy surgery: corticalamygdalohippocampectomy versus selective amygdalohippocampectomy. J Neurosurg 108:5175242008


Téllez-Zenteno JFDhar RHernandez-Ronquillo LWiebe S: Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 130:3343452007


Wechsler D: Wechsler Memory Scale—Third Edition New YorkThe Psychological Corporation1997


Wheatley BM: Selective amygdalohippocampectomy: the trans-middle temporal gyrus approach. Neurosurg Focus 25:3E42008


Wiebe SBlume WTGirvin JPEliasziw MA: A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:3113182001


Wieser HG: Selective amygdalo-hippocampectomy for temporal lobe epilepsy. Epilepsia 29:Suppl 2S100S1131988


Wong CGallate J: The function of the anterior temporal lobe: a review of the empirical evidence. Brain Res 1449:941162012




All Time Past Year Past 30 Days
Abstract Views 44 44 19
Full Text Views 116 116 12
PDF Downloads 96 96 13
EPUB Downloads 0 0 0


Google Scholar