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Lu S, Chu M, Wang X, Wu Y, Hou Y, Liu A. Anterior temporal lobectomy improved mood status and quality of life in Chinese patients with mesial temporal lobe epilepsy: a single-arm cohort study. Chin Med J (Engl) 2023; 136:407-414. [PMID: 36867545 PMCID: PMC10106264 DOI: 10.1097/cm9.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function; whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) remains unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE. METHODS This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery. RESULTS Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P > 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life. CONCLUSIONS Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.
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Affiliation(s)
- Song Lu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
- Fuxing Hospital, Capital Medical University, Beijing 100069, China
| | - Min Chu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Xian Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yating Wu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
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Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study. Acta Neurochir (Wien) 2022; 164:2841-2849. [PMID: 35809147 DOI: 10.1007/s00701-022-05295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/20/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Selective amygdalohippocampectomy (SelAH) is one of the most common surgical treatments for mesial temporal sclerosis. Microsurgical approaches are associated with the risk of cognitive and visual deficits due to damage to the cortex and white matter (WM) pathways. Our objective is to test the feasibility of an endoscopic approach through the anterior middle temporal gyrus (aMTG) to perform a SelAH. METHODS Virtual simulation with MRI scans of ten patients (20 hemispheres) was used to identify the endoscopic trajectory through the aMTG. A cadaveric study was performed on 22 specimens using a temporal craniotomy. The anterior part of the temporal horn was accessed using a tubular retractor through the aMTG after performing a 1.5 cm corticectomy at 1.5 cm posterior to the temporal pole. Then, an endoscope was introduced. SeIAH was performed in each specimen. The specimens underwent neuronavigation-assisted endoscopic SeIAH to confirm our surgical trajectory. WM dissection using Klingler's technique was performed on five specimens to assess WM integrity. RESULTS This approach allowed the identification of collateral eminence, lateral ventricular sulcus, choroid plexus, inferior choroidal point, amygdala, hippocampus, and fimbria. SelAH was successfully performed on all specimens, and CT neuronavigation confirmed the planned trajectory. WM dissection confirmed the integrity of language pathways and optic radiations. CONCLUSIONS Endoscopic SelAH through the aMTG can be successfully performed with a corticectomy of 15 mm, presenting a reduced risk of vascular injury and damage to WM pathways. This could potentially help to reduce cognitive and visual deficits associated with SelAH.
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Moshir Estekhareh SS, Saghebdoust S, Zare R, Hakak MA, Hashemabadi BAG. Memory and executive functioning outcomes of selective amygdalohippocampectomy in patients with hippocampal sclerosis: A preliminary study in a developing country. Surg Neurol Int 2022; 13:161. [PMID: 35509560 PMCID: PMC9062935 DOI: 10.25259/sni_49_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Selective amygdalohippocampectomy (SA) is an effective treatment for drug-resistant cases of epilepsy due to hippocampal sclerosis (HS). However, its neurocognitive outcomes are inconsistent across the previous studies, pointing to potential location-specific confounders. Here, we investigated the neurocognitive outcomes of SA in an Iranian center recently adopting this approach. Methods Thirty adults (53.3% of females, age 31.4 ± 6.2 years) with drug-resistant epilepsy due to HS were included in the study. Patients were stratified into surgical (n = 15) and medical (n = 15) treatment groups based on their preferences. Neurocognitive function was assessed before and 6 months after intervention using Wisconsin Card Sorting Test (WCST), Wechsler Adult Intelligence Scale-Revised, and Wechsler Memory Scale- Third Edition (WMS-III). Postintervention performance changes were compared between the two groups, and predictors of worse postoperative outcomes were investigated. Results Longitudinal changes of performance in WMS-III and WCST were significantly different between the surgically and medically treated patients. Postoperative WMS-III performance showed an average 25% decline (mean ∆T2-T1 = -25.1%, T = -6.6, P < 0.001), and WCST performance improved by an average of 49% (mean ∆T2-T1 = +49.1%, T = 4.6, P < 0.001). The decline in memory performance was more severe in the left-sided surgery and in patients with higher baseline education (mean ∆T2-T1 = -31.1%, T = -8.9, P < 0.001). Conclusion In our center, executive functioning improved or remained stable after SA, but memory functions declined moderately. The left-sided SA and higher education were associated with more severe decline in memory functions, highlighting the need for special considerations for these groups.
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Affiliation(s)
| | - Sajjad Saghebdoust
- Department of Neurosurgery, Epilepsy Center, Razavi Hospital, Mashhad, Iran
| | - Reza Zare
- Department of Neurosurgery, Epilepsy Center, Razavi Hospital, Mashhad, Iran
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Roessler K, Kasper BS, Shawarba J, Walther K, Coras R, Brandner S, Winter F, Hamer H, Blumcke I, Buchfelder M. Operative variations in temporal lobe epilepsy surgery and seizure and memory outcome in 226 patients suffering from hippocampal sclerosis. Neurol Res 2021; 43:884-893. [PMID: 34156329 DOI: 10.1080/01616412.2021.1942407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The aim of this retrospective cohort study was to assess seizure and memory outcomes following temporal lobe surgery in patients suffering from medically refractory temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS).Methods: A retrospective monocentric data analysis was performed in consecutive patients who were operated on during 2002-2018. In the first decennium, standard temporal lobe resections (TLR) were predominately performed, and later, antero-temporal lobe resections (ATLR) were mainly performed. Seizure and memory outcomes over time were assessed according to ILAE/Engel classification and the Berlin Amnesia Test (BTA), respectively.Results: Altogether, 231 surgeries were performed on 226 patients (mean age, 40 years [range, 10-68 years]; male: female, 1:1.4; mean seizure duration, 25 years; and mean follow-up duration, 4.75 years [range, 1-16]). Recently, outcomes of 78.3% of the patients in the total cohort were classified as Engel class I, with 54.9% of patients being completely seizure free. The recent cohort of ATLR since 2012 showed significant more completely seizure-free patients than before 2012 (Engel IA 46.6% versus 67.7%, p < 0.0025, χ2), although the Kaplan Meier analysis of all patients favors TLR for better seizure outcome (61% ATLR vs 73% TLR seizure free after 5 yrs, log rank p < 0.001). Verbal memory improved significantly in non-dominant patients. Minor neurological complications were noted (permanent severe complications, 0.4%; temporary severe complications, 4.8%).Conclusion: Significant improvements in seizure and memory outcomes were observed over time, with surgical technique and seizure duration as important prognostic factors. Early admittance for surgery may favor an excellent seizure outcome in patients undergoing temporal lobe resection for HS.
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Affiliation(s)
- Karl Roessler
- Department of Neurosurgery, Vienna Medical University/AKH Wien, Vienna, Austria.,Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Burkhard S Kasper
- Department of Neurology, University of Erlangen-Nuernberg: Friedrich-Alexander-Universitat Erlangen-Nurnberg, Nuremberg, Germany
| | - Julia Shawarba
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Katrin Walther
- Department of Neurology, University of Erlangen-Nuernberg: Friedrich-Alexander-Universitat Erlangen-Nurnberg, Nuremberg, Germany
| | - Roland Coras
- Department of Neurosurgery, Institute of Neuropathology, University Hospital Erlangen Nuremberg, Nuremberg, Germany
| | | | - Fabian Winter
- Department of Neurosurgery, Vienna Medical University/AKH Wien, Vienna, Austria
| | - Hajo Hamer
- Department of Neurology, University of Erlangen-Nuernberg: Friedrich-Alexander-Universitat Erlangen-Nurnberg, Nuremberg, Germany
| | - Ingmar Blumcke
- Department of Neurosurgery, Institute of Neuropathology, University Hospital Erlangen Nuremberg, Nuremberg, Germany
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Serra C, Akeret K, Staartjes VE, Ramantani G, Grunwald T, Jokeit H, Bauer J, Krayenbühl N. Safety of the paramedian supracerebellar-transtentorial approach for selective amygdalohippocampectomy. Neurosurg Focus 2021; 48:E4. [PMID: 32234984 DOI: 10.3171/2020.1.focus19909] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to assess the reproducibility and safety of the recently introduced paramedian supracerebellar-transtentorial (PST) approach for selective amygdalohippocampectomy (SA). METHODS The authors performed a retrospective analysis of prospectively collected data originating from their surgical register of patients undergoing SA via a PST approach for lesional medial temporal lobe epilepsy. All patients received thorough pre- and postoperative clinical (neurological, neuropsychological, psychiatric) and instrumental (ictal and long-term EEG, invasive EEG if needed, MRI) workup. Surgery-induced complications were assessed at discharge and at every follow-up thereafter and were classified according to Clavien-Dindo grade (CDG). Epilepsy outcome was defined according to Engel classification. Data were reported according to common descriptive statistical methods. RESULTS Between May 2015 and May 2018, 17 patients underwent SA via a PST approach at the authors' institution (hippocampal sclerosis in 13 cases, WHO grade II glioma in 2 cases, and reactive gliosis in 2 cases). The median postoperative follow-up was 7 months (mean 9 months, range 3-19 months). There was no surgery-related mortality and no complication (CDG ≥ 2) in the whole series. Transitory CDG 1 surgical complications occurred in 4 patients and had resolved in all of them by the first postoperative follow-up. One patient showed a deterioration of neuropsychological performance with new slight mnestic deficits. No patient experienced a clinically relevant postoperative visual field defect. No morbidity due to semisitting position was recorded. At last follow-up 13/17 (76.4%) patients were in Engel class I (9/17 [52.9%] were in class IA). CONCLUSIONS The PST approach is a reproducible and safe surgical route for SA. The achievable complication rate is in line with the best results in the literature. Visual function outcome particularly benefits from this highly selective, neocortex-sparing approach. A larger patient sample and longer follow-up will show in the future if the seizure control rate and neuropsychological outcome also compare better than those achieved with current common surgical techniques.
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Affiliation(s)
- Carlo Serra
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich
| | - Kevin Akeret
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich
| | - Victor E Staartjes
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich
| | - Georgia Ramantani
- 2Division of Pediatric Neurology, University Children's Hospital, Zurich
| | - Thomas Grunwald
- 3Department of Neuropsychology, Swiss Epilepsy Clinic, Klinik Lengg AG, Zurich; and
| | - Hennric Jokeit
- 3Department of Neuropsychology, Swiss Epilepsy Clinic, Klinik Lengg AG, Zurich; and
| | - Julia Bauer
- 3Department of Neuropsychology, Swiss Epilepsy Clinic, Klinik Lengg AG, Zurich; and
| | - Niklaus Krayenbühl
- 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich.,4Division of Pediatric Neurosurgery, Children's University Hospital Zurich, Switzerland
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David B, Eberle J, Delev D, Gaubatz J, Prillwitz CC, Wagner J, Schoene-Bake JC, Luechters G, Radbruch A, Wabbels B, Schramm J, Weber B, Surges R, Elger CE, Rüber T. Multi-scale image analysis and prediction of visual field defects after selective amygdalohippocampectomy. Sci Rep 2021; 11:1444. [PMID: 33446810 PMCID: PMC7809286 DOI: 10.1038/s41598-020-80751-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/24/2020] [Indexed: 01/29/2023] Open
Abstract
Selective amygdalohippocampectomy is an effective treatment for patients with therapy-refractory temporal lobe epilepsy but may cause visual field defect (VFD). Here, we aimed to describe tissue-specific pre- and postoperative imaging correlates of the VFD severity using whole-brain analyses from voxel- to network-level. Twenty-eight patients with temporal lobe epilepsy underwent pre- and postoperative MRI (T1-MPRAGE and Diffusion Tensor Imaging) as well as kinetic perimetry according to Goldmann standard. We probed for whole-brain gray matter (GM) and white matter (WM) correlates of VFD using voxel-based morphometry and tract-based spatial statistics, respectively. We furthermore reconstructed individual structural connectomes and conducted local and global network analyses. Two clusters in the bihemispheric middle temporal gyri indicated a postsurgical GM volume decrease with increasing VFD severity (FWE-corrected p < 0.05). A single WM cluster showed a fractional anisotropy decrease with increasing severity of VFD in the ipsilesional optic radiation (FWE-corrected p < 0.05). Furthermore, patients with (vs. without) VFD showed a higher number of postoperative local connectivity changes. Neither in the GM, WM, nor in network metrics we found preoperative correlates of VFD severity. Still, in an explorative analysis, an artificial neural network meta-classifier could predict the occurrence of VFD based on presurgical connectomes above chance level.
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Affiliation(s)
- Bastian David
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Jasmine Eberle
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany ,Clinic for Neurology and Palliative Medicine, Municipal Hospital Köln-Merheim, Cologne, Germany
| | - Daniel Delev
- grid.1957.a0000 0001 0728 696XDepartment of Neurosurgery, RWTH University Aachen, Aachen, Germany
| | - Jennifer Gaubatz
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Conrad C. Prillwitz
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Jan Wagner
- grid.488560.70000 0000 9188 2870Department of Neurology, University of Ulm and Universitäts- and Rehabilitationskliniken Ulm, Ulm, Germany
| | - Jan-Christoph Schoene-Bake
- grid.10423.340000 0000 9529 9877Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Guido Luechters
- grid.10388.320000 0001 2240 3300Center for Development Research, University of Bonn, Bonn, Germany
| | - Alexander Radbruch
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Bettina Wabbels
- grid.15090.3d0000 0000 8786 803XDepartment of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Johannes Schramm
- grid.15090.3d0000 0000 8786 803XMedical Faculty, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- grid.15090.3d0000 0000 8786 803XInstitute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christian E. Elger
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Theodor Rüber
- grid.15090.3d0000 0000 8786 803XDepartment of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany ,grid.7839.50000 0004 1936 9721Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany ,grid.7839.50000 0004 1936 9721Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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Shawarba J, Kaspar B, Rampp S, Winter F, Coras R, Blumcke I, Hamer H, Buchfelder M, Roessler K. Advantages of magnetoencephalography, neuronavigation and intraoperative MRI in epilepsy surgery re-operations. Neurol Res 2021; 43:434-439. [PMID: 33402062 DOI: 10.1080/01616412.2020.1866384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: Management of patients after failed epilepsy surgery is still challenging. Advanced diagnostic and intraoperative tools including magneto-encephalography (MEG) as well as neuronavigation and intraoperative magnetic resonance imaging (iopMRI) may contribute to a better postoperative seizure outcome in this patient group.Methods: We retrospectively analyzed consecutive patients after reoperation of failed epilepsy surgery for medically refractory epilepsy at the University of Erlangen between 1988 and 2017. Inclusion criteria for patients were available MEG, neuronavigation and iopMRI data. The Engel scale was used to categorize seizure outcome.Results: We report on 27 consecutive patients (13 female/14 male mean age at first surgery 29.4 years) who had operative revision of the first resection after failed epilepsy surgery. An improved seizure outcome postoperatively was observed in 78% of patients (p < 0.001) with 55% seizure free (Engel I) patients after a mean follow-up time of 4.9 years. In detail, 80% of lesional cases were seizure free compared to 59% of MRI negative patients. Localizing MEG spike activity in the vicinity of the first resection cavity was present in 12 of 27 patients (44%) corresponding to 83% (10/12) of MEG localizing spike patients having advanced seizure outcome after operative revision.Conclusion: Re-operation after failed surgery in refractory epilepsy may lead to a better seizure outcome in the majority of patients. Preoperative MEG may support the decision for surgery and may facilitate targeting epileptogenic tissue for re-resection by employing navigation and iopMR imaging.
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Affiliation(s)
- Julia Shawarba
- Neurosurgical Department, Erlangen University Clinic, Erlangen, Germany
| | - Burkhard Kaspar
- Neurological Department, Erlangen University Clinic, Erlangen, Germany
| | - Stefan Rampp
- Neurosurgical Department, Erlangen University Clinic, Erlangen, Germany
| | - Fabian Winter
- Neurosurgical Clinic, Vienna Medical University, Vienna, Austria
| | - Roland Coras
- Neuropathological Institute, Erlangen University Clinic, Erlangen, Germany
| | - Ingmar Blumcke
- Neuropathological Institute, Erlangen University Clinic, Erlangen, Germany
| | - Hajo Hamer
- Neurological Department, Erlangen University Clinic, Erlangen, Germany
| | | | - Karl Roessler
- Neurosurgical Department, Erlangen University Clinic, Erlangen, Germany.,Neurosurgical Clinic, Vienna Medical University, Vienna, Austria
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de Souza JPSAS, Ayub G, Nogueira M, Zanao T, Lopes TM, Pimentel-Silva LR, Domene V, Marquez G, Yasuda CL, Ribeiro LF, Campos BM, Vasconcellos J, Rogerio F, Joaquim AF, Cendes F, Tedeschi H, Ghizoni E. Temporopolar amygdalohippocampectomy: seizure control and postoperative outcomes. J Neurosurg 2020; 134:1044-1053. [PMID: 32413857 DOI: 10.3171/2020.3.jns192624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy and safety of a modified surgical approach for the treatment of temporal lobe epilepsy secondary to hippocampal sclerosis (HS). This modified approach, called temporopolar amygdalohippocampectomy (TP-AH), includes a transsylvian resection of the temporal pole and subsequent amygdalohippocampectomy utilizing the limen insula as an anatomical landmark. METHODS A total of 61 patients who were diagnosed with HS and underwent TP-AH between 2013 and 2017 were enrolled. Patients performed pre- and postoperative diffusion tensor imaging and were classified according to Engel's scale for seizure control. To evaluate the functional preservation of the temporal stem white-matter fiber tracts, the authors analyzed postoperative Humphrey perimetries and pre- and postoperative neurocognitive performance (Rey Auditory Verbal Learning Test [RAVLT], Weschler Memory Scale-Revised [WMS-R], intelligence quotient [IQ], Boston Naming Test [BNT], and semantic and phonemic fluency). Demographic data and surgical complications were also recorded and described. RESULTS After a median follow-up of 36 ± 16 months, 46 patients (75.4%) achieved Engel class I, of whom 37 (60.6%) were Engel class IA. No significant changes in either the inferior frontooccipital fasciculus and optic radiation tractography were observed postoperatively for both left- and right-side surgeries. Reliable perimetry was obtained in 40 patients (65.6%), of whom 27 (67.5%) did not present any visual field defects (VFDs) attributable to surgery, while 12 patients (30%) presented with quadrant VFD, and 1 patient (2.5%) presented with hemifield VFD. Despite a significant decline in verbal memory (p = 0.007 for WMS-R, p = 0.02 for RAVLT recognition), there were significant improvements in both IQ (p < 0.001) and visual memory (p = 0.007). Semantic and phonemic fluency, and scores on the BNT, did not change postoperatively. CONCLUSIONS TP-AH provided seizure control similar to historical temporal lobe approaches, with a tendency to preserve the temporal stem and a satisfactory incidence of VFD. Despite a significant decline in verbal memory, there were significant improvements in both IQ and visual memory, along with preservation of executive function. This approach can be considered a natural evolution of the selective transsylvian approach.
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Affiliation(s)
| | | | | | - Tamires Zanao
- 1Neuroimaging Laboratory (LNI), Department of Neurology
| | | | | | | | | | - Clarissa Lin Yasuda
- 1Neuroimaging Laboratory (LNI), Department of Neurology.,3Clinical Neurology
| | | | | | | | - Fabio Rogerio
- 5Department of Anatomical Pathology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Fernando Cendes
- 1Neuroimaging Laboratory (LNI), Department of Neurology.,3Clinical Neurology
| | | | - Enrico Ghizoni
- 1Neuroimaging Laboratory (LNI), Department of Neurology.,Divisions of2Neurosurgery and
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Sharma M, Ball T, Alhourani A, Ugiliweneza B, Wang D, Boakye M, Neimat JS. Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis. Neurosurg Focus 2020; 48:E11. [DOI: 10.3171/2020.1.focus19935] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVESurgery for medically refractory epilepsy (RE) is an underutilized treatment modality, despite its efficacy. Laser interstitial thermal therapy (LITT), which is minimally invasive, is increasingly being utilized for a variety of brain lesions and offers comparable seizure outcomes. The aim of this study was to report the national trends of open surgical procedures for RE with the advent of LITT.METHODSData were extracted using the ICD-9/10 codes from the Nationwide Inpatient Sample (NIS, 2012–2016) in this retrospective study. Patients with a primary diagnosis of RE who underwent either open surgeries (lobectomy, partial lobectomy, and amygdalohippocampectomy) or LITT were included. Patient demographics, complications, hospital length of stay (LOS), discharge disposition, and index hospitalization costs were analyzed. Propensity score matching (PSM) was used to analyze outcomes.RESULTSA cohort of 128,525 in-hospital patients with RE was included and 5.5% (n = 7045) of these patients underwent either open surgical procedures (94.3%) or LITT (5.7%). LITT is increasingly being performed at a rate of 1.09 per 1000 epilepsy admissions/year, while open surgical procedures are decreasing at a rate of 10.4/1000 cases/year. The majority of procedures were elective (92%) and were performed at large-bed-size hospitals (86%). All LITT procedures were performed at teaching facilities and the majority were performed in the South (37%) and West (30%) regions. The median LOS was 1 day for the LITT cohort and 4 days for the open cohort. Index hospitalization charges were significantly lower following LITT compared to open procedures ($108,332 for LITT vs $124,012 for open surgery, p < 0.0001). LITT was associated with shorter median LOS, high likelihood of discharge home, and lower median index hospitalization charges compared to open procedures for RE on PSM analysis.CONCLUSIONSLITT is increasingly being performed in favor of open surgical procedures. LITT is associated with a shorter LOS, a higher likelihood of being discharged home, and lower index hospitalization charges compared to open procedures. LITT is a safe treatment modality in carefully selected patients with RE and offers an opportunity to increase the utilization of surgical treatment in patients who may be opposed to open surgery or have contraindications that preclude open surgery.
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Steinhoff BJ, Staack AM. Is there a place for surgical treatment of nonpharmacoresistant epilepsy? Epilepsy Behav 2019; 91:4-8. [PMID: 29960857 DOI: 10.1016/j.yebeh.2018.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/12/2018] [Accepted: 05/12/2018] [Indexed: 12/11/2022]
Abstract
Epilepsy surgery has been shown to be the best possible treatment in well-defined and difficult-to-treat epilepsy syndromes, such as mesial temporal lobe epilepsy with unilateral hippocampal sclerosis, even early in the course of the disease if pharmacoresistance is proven. This review addresses the question if epilepsy surgery may be justified today even in nonpharmacoresistant cases. There are two possible groups of patients: first, there are epilepsy syndromes with a benign spontaneous course or with a potentially good treatment prognosis under appropriate antiepileptic drug (AED) treatment. Second, there are epilepsies with potentially worse AED treatment prognosis in which appropriate AED treatment has not yet been applied because of the short course of the disease, tolerability problems that prevented usually effective dosing, or adherence issues. In group one, the good spontaneous prognosis or the usually satisfying course under AED treatment in line with the commonly generalized underlying epileptogenesis does not suggest that epilepsy surgery is a realistic alternative, not even in cases with distinct focal clinical and/or electroencephalography (EEG) patterns like in Rolandic epilepsy with centrotemporal spikes. In the second group, the recent International League Against Epilepsy (ILAE) definition should allow assessment of individual pharmacoresistance early after the onset of the disease in order to avoid any delay. Concerns about a potential disease-specific or drug-specific cognitive decline that could be avoided in early surgery are speculative, a matter of controversial discussion, and certainly not relevant, if pharmacoresistance is consequently addressed in time according to the ILAE recommendations. One should also not forget that even in typically pharmacoresistant epilepsy syndromes that are suitable for surgical procedures, satisfying courses do exist that would not require early or any epilepsy surgery. Therefore, in almost any instance, epilepsy surgery as initial treatment or immediately after a first AED is still not recommended although, especially in cases with nonadherence to AEDs, it may be occasionally considered in order to outweigh the risks of ongoing seizures and epilepsy if surgery is not performed.
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