Tag: hippocampal sclerosis

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Selective amygdalohippocampectomy via a navigated temporobasal approach, when veins forbid elevation of the temporal lobe.jpg

Acta Neurochir (2018) 160:597–601

Selective amygdalohippocampectomy is an effective treatment option for mesial temporal lobe epilepsy associated with hippocampal sclerosis.

Methods To describe and emphasize potential pitfalls during selective amygdalohippocampectomy via a modified navigated temporobasal approach, in cases, where temporal basal veins hinder the required elevation of the temporal lobe.

Conclusions Selective amygdalohippocampectomy via navigated temporobasal approach is a safe procedure that can reduce the rate of visual field deficits by avoiding damage of optic radiation. The option of a small subpial corticotomy of the inferior temporal gyrus allows sufficient elevation of the temporal lobe in cases with difficult basal venous anatomy.

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Selective amygdalohippocampectomy via trans-superior temporal gyrus keyhole approach

Selective amygdalohippocampectomy via trans-superior temporal gyrus keyhole approach

Acta Neurochir (2016) 158:785–789

Hippocampal sclerosis is the most common cause of drug-resistant epilepsy amenable for surgical treatment and seizure control. The rationale of the selective amygdalohippocampectomy is to spare cerebral tissue not included in the seizure generator.

Method Describe the selective amygdalohippocampectomy through the trans-superior temporal gyrus keyhole approach.

Conclusion Selective amygdalohippocampectomy for temporal lobe epilepsy is performed when the data (semiology, neuroimaging, electroencephalography) point to the mesial temporal structures. The trans-superior temporal gyrus keyhole approach is a minimally invasive and safe technique that allows disconnection of the temporal stem and resection of temporomesial structures.

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Statistical shape analysis of temporal lobe in mesial temporal sclerosis patients

Statistical shape analysis of temporal lobe in mesial temporal sclerosis patients

Acta Neurochir (2015) 157:1897–1903

Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy due to hippocampal sclerosis but sometimes deciding this diagnosis can be very difficult. We aim to investigate the shape differences in the temporal lobe of mesial temporal sclerosis epilepsy patients compared with healthy controls, investigating the side difference and, if present, assessing the clinical application of this situation.

Method The MRI scans of mesial TLE patients and controls were retrospectively reviewed. Temporal lobe data were collected from the two-dimensional digital images. Standard anthropometric landmarks were selected and marked on each digital image using TPSDIG 2.04 software. Eight anatomic landmarks were marked on images. A generalized Procrustes analysis was used to evaluate the shape difference. The shape deformation of the temporal lobe from control to patient was evaluated using the TPS method.

Results There were statistically significant TL shape differences between groups. High level deformations for the left and right side from the control to patient group were seen in the TPS graphic. The highest deformation was determined at the inferior lateral temporal midpoint of the middle temporal gyri and superior temporal landmark points of both the right and left sides.

Conclusion Our study for the first time demonstrated temporal shape differences in TLE patients using a landmark-based geometrical morphometric method by taking into consideration the topographic distribution of TL.

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Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Anterior temporal lobectomy with amygdalohippocampectomy

J Neurosurg 119:261–272, 2013

In this paper the authors’ goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH).

Methods. The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom.

Results. The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video- EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures.

Conclusions. Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.

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