Abstract
Background
The goal of the present study is the evaluation of the long-term clinical outcome of epilepsy in patients with mesial temporal lobe sclerosis (MTLS) submitted to amygdalohippocampotomy (AHCo). AHCo consists of the lateral ablation of the amygdala and the peri-hippocampal disconnection instead of amygdalohippocampectomy (AHC), which involves the removal of both structures. We previously reported the short-term results of AHCo, so we here present the long-term results (> 5 years of follow-up) of the patients operated on with AHCo.
Method
Since 2007, 35 patients (22 females) aged 20–61 years (mean: 42 years) were operated on with the AHCo technique, 17 patients on the left side and 18 on the right. Of these patients, 21 (14 females) have been followed up > 5 years (5 to 7.5 years, mean 6.5 years). We compare the present results with those observed shortly after surgery and with the patients operated on with AHC.
Findings
In all 21 cases, the diagnosis was mesial temporal lobe sclerosis (histology confirmed in 20), 11 on the left side and 10 on the right.
Epilepsy results after 5 years were good/very good in 18 patients (85.7%), with Engel class IA–B in 15 (71.4%) and II in 3 (14.3%), and bad in 3 patients, with Engel Class III in 2 (9.5%) and class IV in 1 (4.8%). Concerning morbidity, one patient had hemiparesis (hypertensive capsular hemorrhage 24 h after surgery), two verbal memory worsening, two quadrantanopia and three late depression that was reversed with medication.
Comparatively, the AHC long-term results were 87% Engel class I, 8% Engel class II and 5% Engel class III–IV. The morbidity was equally small.
Conclusions
The good/very good results of AHCo 5 years after surgery are 86%, which is not distinct from the AHC results. So AHCo seems to be effective and potentially safer than AHC in long-term follow-up.
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References
Behrens E, Schramm J, Zentner J et al (1997) Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41(1):1–10
Bernasconi N, Bernasconi A, Caramanos Z et al (2003) Mesial temporal damage in temporal lobe epilepsy: a volumetric study of the hippocampus, amygdala and parahippocampal region. Brain 126:462–469
Bogen JE, Vogel PJ (1963) Treatment of generalized seizures by cerebral commissurotomy. Surg Forum 14:431–433
Campero A, Tróccoli G, Martins C et al (2006) Microsurgical approaches to the medial temporal region: an anatomical study. Neurosurgery 59(4 suppl 2):ONS279–ONS308
Chabardès S, Minotti L, Hamelin S et al (2008) Temporal disconnection as an alternative treatment for intractable temporal lobe epilepsy. Neurochirurgie 54:297–302
Choi C, Rubino PA, Fernandez-Miranda JC et al (2006) Meyer’s loop and the optic radiations in the transsylvian approach to the mediobasal temporal lobe. Neurosurgery 59:228–236
Cohen-Gadol AA, Wilhelmi BG, Collignon F et al (2006) Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal sclerosis. J Neurosurg 104:513–524
Delalande O, Pinard JM, Basdevent C et al (1992) Hemispherotomy. Epilepsia 33(Suppl 3):99–100
Duvernoy HM (2005) The human hippocampus, 3rd edn. Springer-Verlag, Berlin
Engel J Jr (1987) Outcome with respect to epileptic seizures. In: Engel J Jr (ed) Surgical treatment of the epilepsies. Raven Press, New York, pp 553–571
Erdem A, Yasargil MG, Roth P (1993) Microsurgical anatomy of the hippocampal arteries. J. Neurosurg 79(2):256–265
Gonçalves-Ferreira A, Miguéns J, Farias JP et al (1994) Selective amygdalo-hippocampectomy: which route is the best? Stereotact Funct Neurosurg 63:182–191
Gonçalves-Ferreira A, Rainha Campos A, Herculano-Carvalho M, the Epilepsy Surgery Group et al (2013) Amygdalohippocampotomy: surgical technique and clinical results. J Neurosurg 118:1107–1113
Hermann BP, Seidenberg M, Dohan FC et al (1995) Reports by patients and their families of memory change after left anterior temporal lobectomy: relationship to degree of hippocampal sclerosis. Neurosurgery 36(1):39–45
Hori T, Tabuchi S, Kurisaki M et al (1993) Subtemporal amygdalohippocampectomy for treating medically intractable temporal lobe epilepsy. Neurosurgery 1993 33(1):50–56
Jehi L (2008) In: Luders HO (ed) Mesial temporal lobectomy: post-surgical seizure frequency. Informa UK Ltd, London, pp 1223–1235
Kanner AM, Balabanov AJ (2008) Psychiatric outcome of epilepsy surgery. In: Luders HO (ed) Epilepsy Surgery. Informa UK Ltd, London, pp 1254–1262
Lopes da Silva F, Witter MP, Boeijinga PH et al (1990) Anatomic organization and physiology of the limbic cortex. Physiol Rev 70:453–511
Luders HO (2008) In: Luders HO (ed) Mesial temporal sclerosis. Informa UK Ltd, London, pp 249–251
Luessenhop AJ (1970) Interhemispheric commissurotomy as an alternative to hemispherectomy for control of intractable seizures. Am Surg 36:265–268
Massager N, Tugendhaft P, Depond C et al (2013) Long-term outcome of surgical disconnectionof the epileptic zone as an alternative to resection for nonlesional mesial temporal epilepsy. J Neurol neurodsurg Psychiatry 84:1378–1383
Mohamed AR, Freeman JL, Maixner W et al (2011) Temporoparietooccipital disconnection in children with intractable epilepsy. J Neurosurg Pediatr 7(6):660–670
Nayel MH, Awad IA, Luders HL (1991) Extent of mesiobasal resection determines output after temporal lobectomy for intractable partial seizures. Neurosurgery 29(1):55–61
Naylor AS, Rogvi-Hansen B, Kessing L et al (1994) Psychiatric morbidity after surgery for epilepsy: short term follow-upof patients undergoing amygdalohippocampectomy. J Neurol Neurosurg Psychiatry 57:1375–1381
Ng WH, Valiante T (2010) Lateral temporal lobectomy with hippocampal disconnection as an alternative surgical technique for temporal lobe epilepsy. J Clin Neurosci 17(5):634–635
Niemeyer P (1958) The transventricular amygdalohippocampectomy in temporal lobe epilepsy. In: Baldwin M, Bailey P (eds) Temporal Lobe Epilepsy. Charles C. Thomas, Springfield, IL, pp 461–482
Ojeman GA, Silbergeld DL (1993) Approaches to epilepsy surgery. Neurosurg Clin N Am 4:183–191
Oliveira JG, Parragua RG, Chaddad-Neto F et al (2012) Supracerebellar transtentorial approach—resection of the tentorium instead of an opening—to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications. J Neurosurg published online January 13:2012. https://doi.org/10.3171/2011.12.JNS111256
Olivier A (1987) Commentary on Cortical Resections. In: Engel J Jr (ed) Surgical treatment of the epilepsies. Raven Press, New York, pp 405–416
Park TS, Bourgeois BF, Silbergeld DL et al (1996) Subtemporal transparahippocampal amygdalohippocampectomy for surgical treatment of mesial temporal lobe epilepsy. J Neurosurg 85:1172–1176
Penfield W, Jasper H (1954) Epilepsy and the functional anatomy of the human brain. J & A Churchill Ltd, London
Peuskens D, Van Loon J, Van Calenbergh F et al (2004) Anatomy of the anterior temporal lobe and the frontotemporal region demonstrated by fiber dissection. Neurosurgery 55(5):1174–1184
Pimentel J, Bentes C, Gonçalves-Ferreira A et al (2010) Long-term and late seizure outcome after surgery for temporal lobe epilepsy. Epileptic Disord 12(1):54–58
Renella RR (1998) Microsurgery of the Temporo-medial Region. Springer-Verlag, Wien
Rougier A, Saint-Hilaire J, Loiseau P et al (1992) Evaluation and surgical treatment of the epilepsies. Neurochirurgie 38(suppl.1):1–112
Rubino PA, Rhoton AL Jr, Tong X et al (2005) Three-dimensional relationships of the optic radiations. Neurosurgery 57(suppl 4):219–227
Rydenhag B, Silander HC (2001) Complications of epileptic surgery after 654 procedures in Sweden, September 1990-1995: a multicentric study based on the Swedish National Epilepsy Surgery Resgister. Neurosurgery 49:51–56
Sasaki-Adams D, Hadar EJ (2008) Temporal lobe epilepsy surgery: surgical complications. In: Luders HO (ed) Epilepsy Surgery. Informa UK Ltd, London, pp 1288–1299
Schramm J (2008) Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 49(8):1296–1307
Schramm J, Behrens E, Entzian W (1995) Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 36:509–516
Schramm J, Lehmann TN, Zentner J et al (2011) Randomized controlled trial of 2.5cm versus 3.5cm mesial temporal resection in temporal lobe epilepsy—part 1: intent-to-treat analysis. Acta Neurochir 153:209–219
Sincoff EH, Tan Y, Abdulrauf SI (2004) White matter fiber dissection of the optic radiations of the temporal lobe and implications for surgical approaches of the temporal horn. J. Neurosurg 101(5):739–746
Sindou M, Guenot M (2003) Surgical anatomy of the temporal lobe for epilepsy surgery. Adv Tech Stand Neurosurg 28:315–343
Smith JR, Vandergriff A, Fountas K (2004) Temporal lobotomy in the surgical management of epilepsy: technical report. Neurosurgery 54:1531–1536
Ture U, Harput MV, Kaya AH et al (2012) The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study. J Neurosurg 116:773–791
Ulm AJ III, Tanriover N, Rothon AL et al (2009) Surgical anatomy of the temporal lobe. In: Barbaro NM, Larson PS (eds) Starr PA. Thieme, New York, pp 16–28
Van Wagenen WP, Herren RY (1940) Surgical division of commissural pathways in the corpus callosum. Arch Neurol Psychiatry 44:740–759
Villemure JG, Mascott CR (1995) Peri-insular hemispherotomy. Neurosurgery 37:975–981
Wiebe S, Blume W, Girvin JP et al (2001) A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345(5):311–318
Wieser HG (2004) ILAE Commission Report: Mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 45(6):695–714
Wieser HG, Yasargil MG (1984) Selective amygdalohippocampectomy as a surgical treatment of mediobasal limbic epilepsy. Surg Neurol 17:445–457
Wen HT, Rhoton AL Jr, Oliveira E et al (1999) Microsurgical anatomy of the temporal lobe, Part I: Mesial temporal lobe and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 45:549–592
Wilson DH et al (1975) Disconnection of the cerebral hemispheres. Neurology 25:1149–1153
Yasargil MG, Teddy PJ, Roth P (1985) Selective amygdalo-hippocampectomy: operative anatomy and surgical technique. Adv Tech Stand Neurosurg 12:93–123
Yasargil MG, Wieser HG, Valavanis A et al (1993) Surgery and results of selective amygdalo-hippocampectomy in one hundred patients with nonlesional limbic epilepsy. Neurosurg Clin N Am 4(2):243–261
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The authors hereby declare that the only source of financial support for this study was the University Hospital Santa Maria where all of the work was done. No other institutional or industrial funding was given to support to this study.
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Author contributions to the study and manuscript preparation include the following: Conception and design: Gonçalves-Ferreira. Acquisition of data: Campos, Franco. Analysis and interpretation of data: Gonçalves-Ferreira, Campos, Franco, Bentes, Peralta, Pimentel. Drafting the article: Gonçalves-Ferreira. Critically revising the article: all authors approved the final version of the manuscript. Administrative/technical/material support: Gonçalves-Ferreira. Study supervision: Gonçalves-Ferreira.
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This study was approved by the Ethics Committee of the University Hospital Santa Maria, Lisbon, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All individual participants in this study gave their informed consent prior to their inclusion in the study
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Gonçalves-Ferreira, A., Rainha-Campos, A., Franco, A. et al. Amygdalohippocampotomy for mesial temporal lobe sclerosis: Epilepsy outcome 5 years after surgery. Acta Neurochir 159, 2443–2448 (2017). https://doi.org/10.1007/s00701-017-3305-y
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DOI: https://doi.org/10.1007/s00701-017-3305-y