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).
开云体育世界杯赔率
作者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.
通信地址:谭Tanriverdi医学博士,神经外科开云体育app官方网站下载入口, Montreal Neurological Institute and Hospital, 3801 University Avenue, Suite 109, Montreal, Quebec H3A 2B4, Canada. email:tanerato2000@yahoo.com.
Abosch
A
,
Bernasconi
N
,
Boling
W
,
Jones-Gotman
M
,
Poulin
N
,
Dubeau
F
,
:
Factors predictive of suboptimal seizure control following selective amygdalohippocampectomy
.J Neurosurg
97
:
1142
- - - - - -
1151
,
2002
10.3171/jns.2002.97.5.1142)| false
Boling
W
,
Olivier
A
:
The current state of epilepsy surgery
.Curr Opin Neurol
11
:
155
- - - - - -
161
,
1998
10.1097/00019052-199804000-00013)| false
BonilhaL,,KobayashiE,,MattosJPV,,HonoratoDC,,LiLM,&CendesF:Value of extend of Hippocampal resection in the surgical treatment of temporal lobe epilepsy.Arq Neuropsiquiatr62:15- - - - - -20,2004
Bonilha
L
,
Kobayashi
E
,
Mattos
JPV
,
Honorato
DC
,
Li
LM
,
Cendes
F
:
Value of extend of Hippocampal resection in the surgical treatment of temporal lobe epilepsy
.Arq Neuropsiquiatr
62
:
15
- - - - - -
20
,
2004
10.1590/S0004-282X2004000100003)| false
ClusmannH,,KralT,,GleissnerU,,SassenR,,UrbachH,&BlümckeI,et al.:Analysis of different types of resection for pediatric patients with temporal lobe epilepsy.开云体育app官方网站下载入口54:847- - - - - -860,2004
Clusmann
H
,
Kral
T
,
Gleissner
U
,
Sassen
R
,
Urbach
H
,
Blümcke
I
,
:
Analysis of different types of resection for pediatric patients with temporal lobe epilepsy
.开云体育app官方网站下载入口
54
:
847
- - - - - -
860
,
2004
10.1227/01.NEU.0000114141.37640.37)| false
ClusmannH,,SchrammJ,,KralT,,HelmstaedterC,,OstertumB,&FimmersR,et al.:Prognostic factors and outcome after different types of resection for temporal lobe epilepsy.J Neurosurg97:1131- - - - - -1141,2002
Clusmann
H
,
Schramm
J
,
Kral
T
,
Helmstaedter
C
,
Ostertum
B
,
Fimmers
R
,
:
Prognostic factors and outcome after different types of resection for temporal lobe epilepsy
.J Neurosurg
97
:
1131
- - - - - -
1141
,
2002
10.3171/jns.2002.97.5.1131)| false
Cohen-GadolA,,WilhelmiBG,,CollignonF,,WhiteJB,,BrittonJW,&CambierDM,et al.:Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis.J Neurosurg104:513- - - - - -524,2006
EngelJJr,,Van NessPC,&RasmussenT,Outcome with respect to epileptic seizures.EngelJJr:Surgical Treatment of the EpilepsiesNew York,Raven Press,1993.609- - - - - -621
Engel
J
Jr
,
Van Ness
PC
,
Rasmussen
T
,
Outcome with respect to epileptic seizures
.
Engel
J
Jr
:Surgical Treatment of the Epilepsies
New York
,
Raven Press
,
1993
.
609
- - - - - -
621)| false
FalconerMA,&TaylorDC:Surgical treatment of drug-resistant epilepsy due to mesial temporal sclerosis: aetiology and significance.Arch Neurol19:353- - - - - -361,1968
Falconer
MA
,
Taylor
DC
:
Surgical treatment of drug-resistant epilepsy due to mesial temporal sclerosis: aetiology and significance
.Arch Neurol
19
:
353
- - - - - -
361
,
1968
10.1001/archneur.1968.00480040019001)| false
Foldvary
N
,
Nashold
B
,
Mascha
E
,
Thompson
EA
,
Lee
N
,
McNamara
JO
,
:
Seizure outcome after temporal lobectomy for temporal lobe epilepsy
.Neurology
54
:
630
- - - - - -
634
,
2000
10.1212/WNL.54.3.630)| false
JooEY,,HanHJ,,LeeEK,,ChoiS,,JinJH,&KimJH,et al.:Resection extent versus postoperative outcomes of seizure and memory in mesial temporal lobe epilepsy.Seizure14:541- - - - - -551,2005
Joo
EY
,
Han
HJ
,
Lee
EK
,
Choi
S
,
Jin
JH
,
Kim
JH
,
:
Resection extent versus postoperative outcomes of seizure and memory in mesial temporal lobe epilepsy
.Seizure
14
:
541
- - - - - -
551
,
2005
10.1016/j.seizure.2005.08.011)| false
Kanner
AM
,
Kaydanova
Y
,
de Toledo-Morrell
L
,
Morrell
F
,
Smith
MC
,
Bergen
D
,
:
Tailored anterior temporal lobectomy. Relation between extent of resection of mesial structures and post-surgical seizure outcome
.Arch Neurol
52
:
173
- - - - - -
178
,
1995
10.1001/archneur.1995.00540260079020)| false
LutzMT,,ClusmannH,,ElgerCE,,SchrammJ,&HelmstaedterC:Neuropsychological outcome after selective amygdalohippocampectomy with transsylvian versus transcortical approach: A randomized prospective clinical trial of surgery for temporal lobe epilepsy.Epilepsia45:809- - - - - -816,2004
MathiesonG:Pathologic aspects of epilepsy with special reference to the surgical pathology of focal cerebral seizures.Adv Neurol8:107- - - - - -138,1975
Mathieson
G
:
Pathologic aspects of epilepsy with special reference to the surgical pathology of focal cerebral seizures
.Adv Neurol
8
:
107
- - - - - -
138
,
1975)| false
McIntosh
AM
,
Wilson
SJ
,
Berkovic
SF
:
Seizure outcome after temporal lobectomy: current research practice and findings
.Epilepsia
42
:
1288
- - - - - -
1307
,
2001
10.1046/j.1528-1157.2001.02001.x)| false
NakasatoN,,LevesqueMF,&BabbTL:Seizure outcome following standard temporal lobectomy: correlation with Hippocampal neuron loss and extrahippocampal pathology.J Neurosurg77:194- - - - - -200,1992
NiemeyerP,The transventricular amygdala-hippocampectomy in the temporal lobe epilepsy.BaldwinM,&BaileyP:The Temporal Lobe EpilepsySpringfield, IL,Charles C Thomas,1958.461- - - - - -482
Niemeyer
P
,
The transventricular amygdala-hippocampectomy in the temporal lobe epilepsy
.
Baldwin
M
,
Bailey
P
:The Temporal Lobe Epilepsy
Springfield, IL
,
Charles C Thomas
,
1958
.
461
- - - - - -
482)| false
OlivierA:Risk and benefit in the surgery of epilepsy: complications and positive results on seizure tendency and intellectual function.Acta Neurol Scand117:Suppl114- - - - - -121,1988
Olivier
A
:
Risk and benefit in the surgery of epilepsy: complications and positive results on seizure tendency and intellectual function
.Acta Neurol Scand
117
:
Suppl
114
- - - - - -
121
,
1988)| false
Olivier
A
,
Alonso-Vanegas
M
,
Comeau
R
,
Peters
TM
:
Image-guided surgery of epilepsy
.Neurosurg Clin N Am
7
:
229
- - - - - -
243
,
1996
10.1016/S1042-3680(18)30389-9)| false
OlivierA,,GloorP,,QuesneyLF,&AndermannF:The indications for and the role of depth electrode recording in epilepsy.Appl Neurophysiol46:33- - - - - -36,1983
Olivier
A
,
Gloor
P
,
Quesney
LF
,
Andermann
F
:
The indications for and the role of depth electrode recording in epilepsy
.Appl Neurophysiol
46
:
33
- - - - - -
36
,
1983)| false
Ozkara
C
,
Ozyurt
E
,
Hanoglu
L
,
Eskazan
E
,
Dervent
A
,
Kocer
N
,
:
Surgical outcome of epilepsy patients evaluated with a non-invasive protocol
.Epilepsia
41
:
Suppl
S41
- - - - - -
S44
,
2000
10.1111/j.1528-1157.2000.tb01545.x)| false
PaglioliE,,PalminiA,,PaglioliE,,da CostaJC,,PortuguezM,&MartinezJV,et al.:Survival analysis of the surgical outcome of temporal lobe epilepsy due to hippocampal sclerosis.Epilepsia45:1383- - - - - -1391,2004
Paglioli
E
,
Palmini
A
,
Paglioli
E
,
da Costa
JC
,
Portuguez
M
,
Martinez
JV
,
:
Survival analysis of the surgical outcome of temporal lobe epilepsy due to hippocampal sclerosis
.Epilepsia
45
:
1383
- - - - - -
1391
,
2004
10.1111/j.0013-9580.2004.22204.x)| false
Paglioli
E
,
Palmini
A
,
Portuguez
M
,
Paglioli
E
,
Azambuja
N
,
da Costa
JC
,
:
Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis
.J Neurosurg
104
:
70
- - - - - -
78
,
2006
10.3171/jns.2006.104.1.70)| false
RadhakrishnanK,,SoEL,,SilbertPL,,JackCRJr,,CascinoGD,&SharbroughFW,et al.:Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study.Neurology51:465- - - - - -471,1998
Radhakrishnan
K
,
So
EL
,
Silbert
PL
,
Jack
CR
Jr
,
Cascino
GD
,
Sharbrough
FW
,
:
Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study
.Neurology
51
:
465
- - - - - -
471
,
1998
10.1212/WNL.51.2.465)| false
RydenhagB,&SilanderHC:Complications of epilepsy surgery after 654 procedures in Sweden, September 1990–1995: a multi-center study based on Swedish National Epilepsy Surgery Register.开云体育app官方网站下载入口49:51- - - - - -57,2001
Rydenhag
B
,
Silander
HC
:
Complications of epilepsy surgery after 654 procedures in Sweden, September 1990–1995: a multi-center study based on Swedish National Epilepsy Surgery Register
.开云体育app官方网站下载入口
49
:
51
- - - - - -
57
,
2001)| false
Salanova
V
,
Andermann
F
,
Rasmussen
T
,
Olivier
A
,
Quesney
L
:
The running down phenomenon in temporal lobe epilepsy
.Brain
119
:
989
- - - - - -
996
,
1996
10.1093/brain/119.3.989)| false
SeidenbergM,,WylerAR,,DohanFCJr,,HermannB,,DaviesK,&LeveroniC:Neuropsychological outcome following anterior temporal lobectomy in patients with and without the syndrome of mesial temporal lobe epilepsy.Neuropsychology12:303- - - - - -316,1998
Seidenberg
M
,
Wyler
AR
,
Dohan
FC
Jr
,
Hermann
B
,
Davies
K
,
Leveroni
C
:
Neuropsychological outcome following anterior temporal lobectomy in patients with and without the syndrome of mesial temporal lobe epilepsy
.Neuropsychology
12
:
303
- - - - - -
316
,
1998
10.1037/0894-4105.12.2.303)| false
SonEI,,HowardMA,,OjemannGA,&LettichE:Comparing the extent of hippocampal removal to the outcome in terms of seizure control.Stereotact Funct Neurosurg62:232- - - - - -237,1994
Son
EI
,
Howard
MA
,
Ojemann
GA
,
Lettich
E
:
Comparing the extent of hippocampal removal to the outcome in terms of seizure control
.Stereotact Funct Neurosurg
62
:
232
- - - - - -
237
,
1994
10.1159/000098625)| false
WylerAR,,HermannBP,&SomesG:Extent of medial temporal resection on outcome from anterior temporal lobectomy: a randomized prospective study.开云体育app官方网站下载入口37:982- - - - - -990,1995
Wyler
AR
,
Hermann
BP
,
Somes
G
:
Extent of medial temporal resection on outcome from anterior temporal lobectomy: a randomized prospective study
.开云体育app官方网站下载入口
37
:
982
- - - - - -
990
,
1995
10.1227/00006123-199511000-00019)| false
