Background: Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. Objectives: We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. Material and Methods: 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). Results: SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. Conclusion: Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results.

Keywords:
Epilepsy surgery, Temporal lobe epilepsy, Memory, Outcome, MRI volumetry, Amygdalohippocampectomy
1.
Telles-Zenteno JF, Dhar R, Wiebe S: Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain 2005;128:1188-1198.
2.
Niemeyer P: The transventricular amygdalohippocampectomy in temporal lobe epilepsy; in Baldwin M, Bailey P (eds): Temporal Lobe Epilepsy. Springfield, Charles C. Thomas, 1958, pp 461-482.
3.
Yasargil MG, Teddy PJ, Roth P: Selective amygdalohippocampectomy. Operative anatomy and surgical technique. Adv Tech Stand Neurosurg 1985;12:93-123.
4.
Josephson CB, Dykeman J, Fiest KM, Liu X, Sadler RM, Jette N, Wiebe S: Systematic review and meta-analysis of standard vs. selective temporal lobe epilepsy surgery. Neurology 2013;80:1669-1676.
5.
Liscak R, Malikova H, Kalina M, Vojtech Z, Prochazka T, Marusic P, Vladyka V: Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy. Acta Neurochir 2010;152:1291-1298.
6.
Talairach J, Bancaud J, Szikla G, Bonis A, Geier S, Vedrenne C: New approach to the neurosurgery of epilepsy. Stereotaxic methodology and therapeutic results. 1. Introduction and history (in French). Neurochirurgie 1974;20(suppl 1):1-240.
7.
Vladyka V: Surgical treatment of epilepsy and its application in temporal epilepsy (in Czech). Cesk Neurol Neurochir 1978;41:95-106.
8.
Parrent AG, Blume WT: Stereotactic amygdalohippocampotomy for the treatment of medial temporal lobe epilepsy. Epilepsia 1999;40:1408-1416.
9.
Vojtech Z, Kramska L, Malikova H, Seltenreichova K, Prochazka T, Kalina M, Liscak R: Cognitive outcome after stereotactic amygdalohippocampectomy. Seizure 2012;21:327-333.
10.
Malikova H, Kramska L, Vojtech Z, Lukavsky J, Liscak R: Stereotactic radiofrequency amygdalohippocampectomy: two years of good neuropsychological outcomes. Epilepsy Res 2013;106:423-432.
11.
Roberti F, Potolicchio SJ, Caputy AJ: Tailored anteromedial lobectomy in the treatment of refractory epilepsy of the temporal lobe: long term surgical outcome and predictive factors. Clin Neurol Neurosurg 2007;109:158-165.
12.
Watson C, Jack CR, Cendes F: Volumetric magnetic resonance imaging. Clinical applications and contributions to the understanding of temporal lobe epilepsy. Arch Neurol 1997;42:1521-1531.
13.
Engel J Jr, Van Ness PC, Rasmussen TB, et al: Outcome with respect to seizures; in Engel J Jr (ed): Surgical Treatment of the Epilepsies, ed 2. New York, Raven Press, 1993, pp 609-621.
14.
Wechsler D: Manual for the Wechsler Memory Scale Revised. San Antonio, The Psychological Corporation, 1987.
15.
R Development Core Team: A language and environment for statistical computing. Vienna, R Foundation for Statistical Computing, 2013. http://www.rproject.org.
16.
Malikova H, Vojtech Z, Liscak R, Prochazka T, Vymazal J, Vladyka V, Druga R: Stereotactic radiofrequency amygdalohippocampectomy: does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome? Epilepsia 2011;52:932-940.
17.
Kondo H, Lavenex P, Amaral DG: Intrinsic connections of the macaque monkey hippocampal formation: I. Dentate gyrus. J Comp Neurol 2008;511:497-520.
18.
Kondo H, Lavenex P, Amaral DG: Intrinsic connections of the macaque monkey hippocampal formation: II. CA 3 connections. J Comp Neurol 2009;515:349-377.
19.
Hader WJ, Telles-Zenteno J, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Kwon CS, Jette N: Complications of epilepsy surgery - a systematic review of focal surgical resections and invasive EEG monitoring. Epilepsia 2013;54:840-847.
20.
Sirven JI: The silent gap between epilepsy surgery evaluation and clinical practice guidelines. Eur J Neurol 2010;17:522-523.
21.
Kumlien E, Mattsson P: Attitudes towards epilepsy surgery: a nationwide surgery among Swedish neurologists. Seizure 2010;19:253-255.
22.
Tanriverdi T, Aljan A, Poulin N, Olivier A: Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution. J Neurosurg 2009;110:1111-1123.
23.
Engel J Jr, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S, Sperling MR, Gardiner I, Erba G, Fried I, Jacobs M, Vinters HV, Mintzer S, Kieburtz K: Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA 2012;307:922-930.
24.
Lee TM, Yip JT, Jones-Gotman M: Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. Epilepsia 2002;43:283-291.
25.
Barr WB, Chelune GJ, Hermann BP, Loring DW, Perrine K, Strauss E, Trenerry MR, Westerveld M: The use of figural reproduction tests as measures of nonverbal memory in epilepsy surgery candidates. J Int Neuropsychol Soc 1997;3:435-443.
26.
Walton NH, Goodsman C, McCarter R, Sandeman DR, Bird JM: An analysis of neuropsychological change scores following selective temporal resection of the non-dominant temporal lobe. Seizure 1999;8:241-245.
27.
Malikova H, Kramska L, Liscak R, Vojtech Z, Prochazka T, Mareckova I, Lukavsky J, Druga R: Stereotactic radiofrequency amygdalohippocampectomy for the treatment of temporal lobe epilepsy: do good neuropsychological and seizure outcomes correlate with hippocampal volume reduction? Epi Res 2012;102:34-44.
28.
Régis J, Rey M, Vladyka V, Liscak R, Schröttner O, Pendl G: Gamma knife surgery in mesial temporal lobe epilepsy: a prospective multicenter study. Epilepsia 2004;45:504-515.
29.
Srikijvilaikul T, Najm I, Foldvary-Schaefer N, Lineweaver T, Suh JH, Bingaman WE: Failure of gamma knife radiosurgery for mesial temporal lobe epilepsy: report of five cases. Neurosurgery 2004;54:1395-1402.
30.
Vojtěch Z, Vladyka V, Kalina M, Nešpor E, Seltenreichová K, Šemnická J, Liščák R: The use of radiosurgery for the treatment of mesial temporal lobe epilepsy and long-term results. Epilepsia 2009;50:2061-2071.
31.
Willie JT, Laxpati, NG, Drane DL, Gowda A, Appin C, Hao C, Brat D, Helmers SL, Saindane A, Nour SG, Gross RE: Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery 2014;74:569-585.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.