Transsylvian amygdalohippocampectomy for mesial temporal lobe epilepsy: Comparison of three different approaches
Objective This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline. Methods We included 114 consecutive patients with unilatera...
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Published in | Epilepsia (Copenhagen) Vol. 62; no. 2; pp. 439 - 449 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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01.02.2021
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Abstract | Objective
This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline.
Methods
We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI‐AH, TU‐AH, or TP‐AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre‐ and postoperative memory performance and intelligence quotient (IQ).
Results
There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow‐up with TP‐AH (69.5%) and TI‐AH (76.7%) as compared to the TU‐AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto‐occipital fasciculus postoperatively was reduced in the TI‐AH group compared with the TU‐AH and TP‐AH groups (p = .001). The rate of visual field defects was significantly higher with TI‐AH (14/19, 74%) in comparison to the TU‐AH (5/15, 33%) and TP‐AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left‐sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP‐AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right‐ and left‐sided surgeries.
Significance
The TP‐AH group had better short‐term seizure control than TU‐AH, a lower rate of visual field defects than TI‐AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP‐AH is a better surgical approach for temporal lobe epilepsy with HS than TI‐AH and TU‐AH. |
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AbstractList | This study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline.
We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI-AH, TU-AH, or TP-AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre- and postoperative memory performance and intelligence quotient (IQ).
There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow-up with TP-AH (69.5%) and TI-AH (76.7%) as compared to the TU-AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto-occipital fasciculus postoperatively was reduced in the TI-AH group compared with the TU-AH and TP-AH groups (p = .001). The rate of visual field defects was significantly higher with TI-AH (14/19, 74%) in comparison to the TU-AH (5/15, 33%) and TP-AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left-sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP-AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right- and left-sided surgeries.
The TP-AH group had better short-term seizure control than TU-AH, a lower rate of visual field defects than TI-AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP-AH is a better surgical approach for temporal lobe epilepsy with HS than TI-AH and TU-AH. ObjectiveThis study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline.MethodsWe included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI‐AH, TU‐AH, or TP‐AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre‐ and postoperative memory performance and intelligence quotient (IQ).ResultsThere were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow‐up with TP‐AH (69.5%) and TI‐AH (76.7%) as compared to the TU‐AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto‐occipital fasciculus postoperatively was reduced in the TI‐AH group compared with the TU‐AH and TP‐AH groups (p = .001). The rate of visual field defects was significantly higher with TI‐AH (14/19, 74%) in comparison to the TU‐AH (5/15, 33%) and TP‐AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left‐sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP‐AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right‐ and left‐sided surgeries.SignificanceThe TP‐AH group had better short‐term seizure control than TU‐AH, a lower rate of visual field defects than TI‐AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP‐AH is a better surgical approach for temporal lobe epilepsy with HS than TI‐AH and TU‐AH. Objective This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline. Methods We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI‐AH, TU‐AH, or TP‐AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre‐ and postoperative memory performance and intelligence quotient (IQ). Results There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow‐up with TP‐AH (69.5%) and TI‐AH (76.7%) as compared to the TU‐AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto‐occipital fasciculus postoperatively was reduced in the TI‐AH group compared with the TU‐AH and TP‐AH groups (p = .001). The rate of visual field defects was significantly higher with TI‐AH (14/19, 74%) in comparison to the TU‐AH (5/15, 33%) and TP‐AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left‐sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP‐AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right‐ and left‐sided surgeries. Significance The TP‐AH group had better short‐term seizure control than TU‐AH, a lower rate of visual field defects than TI‐AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP‐AH is a better surgical approach for temporal lobe epilepsy with HS than TI‐AH and TU‐AH. Abstract Objective This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline. Methods We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI‐AH, TU‐AH, or TP‐AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre‐ and postoperative memory performance and intelligence quotient (IQ). Results There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow‐up with TP‐AH (69.5%) and TI‐AH (76.7%) as compared to the TU‐AH (43.5%) approach ( p = .03). The number of fibers of the inferior fronto‐occipital fasciculus postoperatively was reduced in the TI‐AH group compared with the TU‐AH and TP‐AH groups ( p = .001). The rate of visual field defects was significantly higher with TI‐AH (14/19, 74%) in comparison to the TU‐AH (5/15, 33%) and TP‐AH (13/40, 32.5%) approaches ( p = .008). Finally, there was a significant postoperative decline in verbal memory in left‐sided surgeries ( p = .019) and delayed recall for both sides ( p < .001) regardless of the surgical approach. However, TP‐AH was the only group that showed a significant improvement in visual memory ( p < .001) and IQ ( p < .001) for both right‐ and left‐sided surgeries. Significance The TP‐AH group had better short‐term seizure control than TU‐AH, a lower rate of visual field defects than TI‐AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP‐AH is a better surgical approach for temporal lobe epilepsy with HS than TI‐AH and TU‐AH. |
Author | Zanao, Tamires Rogerio, Fabio de Souza, João P. S. A. S. Tedeschi, Helder Nogueira, Mateus H. Cendes, Fernando Ghizoni, Enrico Campos, Brunno M. Yasuda, Clarissa L. Pimentel‐Silva, Luciana R. Ayub, Gabriel |
Author_xml | – sequence: 1 givenname: João P. S. A. S. orcidid: 0000-0002-2523-9806 surname: de Souza fullname: de Souza, João P. S. A. S. organization: University of Campinas – sequence: 2 givenname: Luciana R. orcidid: 0000-0001-5045-9512 surname: Pimentel‐Silva fullname: Pimentel‐Silva, Luciana R. organization: University of Campinas – sequence: 3 givenname: Gabriel surname: Ayub fullname: Ayub, Gabriel organization: University of Campinas – sequence: 4 givenname: Mateus H. surname: Nogueira fullname: Nogueira, Mateus H. organization: University of Campinas – sequence: 5 givenname: Tamires orcidid: 0000-0001-7868-4332 surname: Zanao fullname: Zanao, Tamires organization: University of Campinas – sequence: 6 givenname: Clarissa L. surname: Yasuda fullname: Yasuda, Clarissa L. organization: University of Campinas – sequence: 7 givenname: Brunno M. orcidid: 0000-0003-1261-8257 surname: Campos fullname: Campos, Brunno M. organization: University of Campinas – sequence: 8 givenname: Fabio surname: Rogerio fullname: Rogerio, Fabio organization: University of Campinas – sequence: 9 givenname: Helder surname: Tedeschi fullname: Tedeschi, Helder organization: University of Campinas – sequence: 10 givenname: Fernando orcidid: 0000-0001-9336-9568 surname: Cendes fullname: Cendes, Fernando organization: University of Campinas – sequence: 11 givenname: Enrico surname: Ghizoni fullname: Ghizoni, Enrico email: eghizoni@unicamp.br organization: University of Campinas |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33449366$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_3389_fneur_2021_801195 crossref_primary_10_1111_epi_17490 crossref_primary_10_1016_j_wneu_2023_06_017 crossref_primary_10_1080_23279095_2022_2036990 |
Cites_doi | 10.1016/j.seizure.2017.11.011 10.1111/epi.16309 10.3171/2013.8.JNS121854 10.3171/2017.4.JNS162699 10.1016/j.yebeh.2006.04.017 10.1016/j.yebeh.2014.04.028 10.3171/2019.10.JNS191932 10.3171/2018.4.PEDS17607 10.1093/brain/awh512 10.3389/fnana.2016.00088 10.1016/j.wneu.2016.11.056 10.3171/2020.3.JNS192624 10.1093/brain/aww280 10.1136/jnnp-2017-317783 10.3389/fnins.2019.01185 10.3171/2009.6.JNS08132 10.1007/s00234-019-02281-2 10.3171/2020.1.FOCUS19937 10.1227/NEU.0b013e3182556fde 10.1093/brain/awh221 10.1227/01.NEU.0000348564.28415.FA 10.3171/2017.3.JNS162821 10.1016/j.seizure.2005.10.005 10.1007/978-3-7091-7008-3_2 10.1136/jnnp-2012-304038 10.1111/j.1528-1167.2008.01625.x 10.3171/foc.2005.18.6.16 10.1093/brain/awt094 10.3171/2014.10.JNS141194 10.3171/2015.1.JNS141811 10.1055/s-0035-1549303 10.3171/jns.2006.104.1.70 10.1212/WNL.0b013e3182904f82 10.1111/epi.12220 10.1016/j.yebeh.2017.12.007 10.3171/2011.12.FOCUS11318 10.1227/01.NEU.0000324895.19708.68 10.3171/2008.12.JNS081112 10.1016/j.seizure.2020.01.018 10.1016/j.yebeh.2017.08.037 10.3171/JNS/2008/109/9/0461 10.3171/2012.1.FOCUS11340 |
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Snippet | Objective
This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches... This study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches regarding... Abstract Objective This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy... ObjectiveThis study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches... OBJECTIVEThis study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches... |
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SubjectTerms | Adult Amygdala - surgery amygdalohippocampectomy Anterior Temporal Lobectomy Cerebral Cortex Cognition Convulsions & seizures Diffusion Tensor Imaging Drug Resistant Epilepsy - surgery Epilepsy Epilepsy, Temporal Lobe - surgery Female hippocampal sclerosis Hippocampus Hippocampus - pathology Hippocampus - surgery Humans Intelligence Intelligence Tests Magnetic resonance imaging Male Memory Middle Aged Neurosurgical Procedures - methods Parahippocampal Gyrus Postoperative Cognitive Complications - epidemiology Postoperative Cognitive Complications - physiopathology Prospective Studies Sclerosis Seizures Surgery Survival analysis Temporal Lobe temporal lobe epilepsy temporal stem tractography Treatment Outcome Visual field Visual Fields |
Title | Transsylvian amygdalohippocampectomy for mesial temporal lobe epilepsy: Comparison of three different approaches |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fepi.16816 https://www.ncbi.nlm.nih.gov/pubmed/33449366 https://www.proquest.com/docview/2489101592/abstract/ https://search.proquest.com/docview/2478589346 |
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