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Pitskhelauri D, Kudieva E, Vlasov P, Eliseeva N, Zaitsev O, Kamenetskaya M, Kozlova A, Shishkina L, Danilov G, Sanikidze A, Kuprava T, Ishkinin R, Melikyan A. Burr hole microsurgical subtemporal selective amygdalohippocampectomy. Acta Neurochir (Wien) 2023; 165:1215-1226. [PMID: 36867249 DOI: 10.1007/s00701-023-05536-3] [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: 10/14/2022] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION At present, selective amygdalohippocampectomy (SAH) has become popular in the treatment of drug-resistant mesial temporal lobe epilepsy (TLE). However, there is still an ongoing discussion about the advantages and disadvantages of this approach. METHODS The study included a consecutive series of 43 adult patients with drug-resistant TLE, involving 24 women and 19 men (1.8/1). Surgeries were performed at the Burdenko Neurosurgery Center from 2016 to 2019. To perform subtemporal SAH through the burr hole with the diameter of 14 mm, we used two types of approaches: preauricular, 25 cases, and supra-auricular, 18 cases. The follow-up ranged from 36 to 78 months (median 59 months). One patient died 16 months after surgery (accident). RESULTS By the third year after surgery, Engel I outcome was achieved in 80.9% (34 cases) of cases and Engel II in 4 (9.5%) and Engel III and Engel IV in 4 (9.6%) cases. Among the patients with Engel I outcomes, anticonvulsant therapy was completed in 15 (44.1%), and doses were reduced in 17 (50%) cases. Verbal and delayed verbal memory decreased after surgery in 38.5% and 46.1%, respectively. Verbal memory was mainly affected by preauricular approach in comparison with supra-auricular (p = 0.041). In 15 (51.7%) cases, minimal visual field defects were detected in the upper quadrant. At the same time, visual field defects did not extend into the lower quadrant and inside the 20° of the upper affected quadrant in any case. CONCLUSIONS Burr hole microsurgical subtemporal SAH is an effective surgical procedure for drug-resistant TLE. It involves minimal risks of loss of visual field within the 20° of the upper quadrant. Supra-auricular approach, compared to preauricular, results in a reduction in the incidence of upper quadrant hemianopia and is associated with a lower risk of verbal memory impairment.
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Affiliation(s)
- David Pitskhelauri
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia.
| | - Elina Kudieva
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Pavel Vlasov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Natalya Eliseeva
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Oleg Zaitsev
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Maria Kamenetskaya
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Antonina Kozlova
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Ludmila Shishkina
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Gleb Danilov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Alexander Sanikidze
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | | | - Ruslan Ishkinin
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Armen Melikyan
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
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Pitskhelauri DI, Kudieva ES, Melikyan AG, Vlasov PA, Kamenetskaya MI, Zaitsev OS, Kozlova AB, Eliseeva NM, Shishkina LV, Danilov GV, Nagorskaya IA, Sanikidze AZ, Melnikova-Pitskhelauri TV, Pronin IN, Konovalov AN. [Surgical treatment of drug-resistant epilepsy following hippocampal sclerosis]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:31-40. [PMID: 34714001 DOI: 10.17116/neiro20218505131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgery is an effective approach for drug-resistant temporal lobe epilepsy following hippocampal sclerosis. There is still no clear and unanimous opinion about advantages and disadvantages of certain surgical technique. MATERIAL AND METHODS There were 103 surgical interventions in 101 patients. Females prevailed (1.45:1). Age of patients ranged from 16 to 56 years (median 28). Anteromedial temporal lobectomy and selective amygdaloghippocampectomy were performed in 49 (47.6%) and 54 (52.4%) patients, respectively. In the latter group, 30 patients were operated via a 14-mm burr hole-subtemporal approach. Postoperative outcomes were assessed using the Engel grading system. The follow-up period ranged from 2 to 8 years (median 4 years). RESULTS By the 2nd year, Engel class I was observed in 74 (72%) patients, Engel II, III and IV - in 20 (19.4%), 6 (5.8%) and 3 (2.9%) patients, respectively. Engel class I was achieved after anteromedial temporal lobectomy in 68% of cases, selective amygdaloghippocampectomy via standard approaches in 75% of cases, amygdaloghippocampectomy via subtemporal burr hole approach - in 80% of cases. Neurocognitive impairments after anteromedial lobectomy and selective amygdaloghippocampectomy were similar. At the same time, mental disorders de novo prevailed in the group of anteromedial lobectomy (p<0.05). There were no severe visual field disorders after subtemporal burr-hole access. In other cases, these disorders occurred in 36.2% of patients (p<0.05). There were 8 (7.8%) postoperative complications: 5 (10.2%) - after anterior temporal lobectomy, 3 (5.5%) - after selective surgeries via standard approaches. There were no complications after burr-hole surgery. CONCLUSION Selective amygdaloghippocampectomy is not inferior to anteromedial lobectomy. Moreover, this procedure is associated with a lower risk of complications and adverse events.
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Affiliation(s)
| | - E S Kudieva
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - P A Vlasov
- Burdenko Neurosurgical Center, Moscow, Russia.,Center for Epileptology and Neurology, Moscow, Russia
| | | | - O S Zaitsev
- Burdenko Neurosurgical Center, Moscow, Russia.,Privolzhskiy Research Medical University, Nizhniy Novgorod, Russia
| | - A B Kozlova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - G V Danilov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Xu K, Wang X, Guan Y, Zhao M, Zhou J, Zhai F, Wang M, Li T, Luan G. Comparisons of the seizure-free outcome and visual field deficits between anterior temporal lobectomy and selective amygdalohippocampectomy: A systematic review and meta-analysis. Seizure 2020; 81:228-235. [DOI: 10.1016/j.seizure.2020.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
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