Neuropsychological Outcome and the Extent of Resection in the Unilateral Temporal Lobectomy

2001 ◽  
Vol 2 (2) ◽  
pp. 140-151 ◽  
Author(s):  
Francis J.X. Graydon ◽  
Julia A. Nunn ◽  
Charles E. Polkey ◽  
Robin G. Morris
Keyword(s):  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Neuropsychological Outcome

Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Mohamed H. Nayel ◽  
Issam A. Awad ◽  
Hans Luders
Keyword(s):  
Temporal Lobe ◽  
Seizure Frequency ◽  
Compartment Model ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Lateral Structures

Abstract The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P<0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P<0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)

Selective amygdalohippocampectomy via the transsylvian approach

2008 ◽  
Vol 25 (3) ◽  
pp. E5 ◽  
Author(s):  
Badih Adada
Keyword(s):  
Visual Field ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Neuropsychological Outcome ◽  
Transsylvian Approach ◽  
Selective Amygdalohippocampectomy ◽  
Established Treatment

Surgery is an established treatment for temporal lobe epilepsy refractory to medication. Several surgical approaches have been used to treat this condition including temporal lobectomy, transcortical selective amygdalohippocampectomy, subtemporal amygdalohippocampectomy, and transsylvian amygdalohippocampectomy. In this article the author reviews the transsylvian amygdalohyppocampectomy and pertinent anatomy. He also discusses the procedure's results with regard to seizure control, neuropsychological outcome, and visual field preservation.

scholarly journals Postoperative Neuropsychological Outcome in Patients with Mesial Temporal Lobe Epilepsy in Argentina

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Silvia Oddo ◽  
Patricia Solis ◽  
Damian Consalvo ◽  
Eduardo Seoane ◽  
Brenda Giagante ◽  
...  
Keyword(s):  
Executive Function ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Visual Memory ◽  
Mesial Temporal Lobe Epilepsy ◽  
Memory Deficit ◽  
Temporal Lobectomy ◽  
Neuropsychological Outcome ◽  
Mesial Temporal Lobe

The aim of the present study is to compare pre- and postsurgical neuropsychological outcome in individuals suffering from mesial temporal lobe epilepsy (mTLE), in order to evaluate prognosis. The selected thirty-five patients had medically mTLE and had undergone an anterior temporal lobectomy (ATL). Neuropsychological evaluation was performed in three different stages: before ATL, 6 months after resection, and a year afterwards. Neuropsychological protocol evaluated attention, verbal memory, visual memory, executive function, language, intelligence, and handedness. There was a significant improvement () in the group with visual memory deficit after surgery, whereas no changes were observed across patients with verbal memory deficit. No changes were observed in language after surgery. Executive function showed significant improvement 6 months after surgery (). Postoperative outcome of cognitive impairments depends on baseline neuropsychological status of the patients with TLE. In our case series, deficits found in patients with mTLE after ATL did not result in a subjective complaint.

scholarly journals Pharmacoresistant temporal epilepsy: the relationship of epileptiform activity and structural changes in the hippocampus

2020 ◽  
Vol 7 (6) ◽  
pp. 46-54
Author(s):  
S. E. Cherenkova ◽  
E. V. Marchenko ◽  
A. M. Alexandrov ◽  
N. V. Arkhipova ◽  
A. A. Chukhlovin ◽  
...  
Keyword(s):  
Structural Changes ◽  
Specific Activity ◽  
Hippocampal Sclerosis ◽  
Epileptiform Activity ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Research Centre ◽  
Temporal Epilepsy ◽  
The Relationship ◽  
Epileptic System

Background. Hippocampal sclerosis is one of the most common structural lesions associated with epilepsy. The standard medical care in the treatment of drug-resistant temporal lobe epilepsy associated with hippocampal sclerosis is surgery with anterior temporal lobectomy. The extent of resection depends on the involvement of hippocampal sclerosis in the epileptic system. Objective. Determine the relationship between the involvement of the hippocampus in the epileptic system (on the basis of the results of intraoperative electrocorticography (ECoG)) and the presence of structural changes in it, found on the basis of MRI data. Materials and methods. The present article presents an original retrospective study of the dependence of the signs of hippocampal sclerosis according to neuroimaging data and the formation of epileptiform activity in 36 patients treated at the Polenov Neurosurgical Institute — branch of Almazov National Medical Research Centre in 2015–2018. Results. Depending on the presence of hippocampal sclerosis and epileptiform activity, patients were divided into 4 groups: 1) patients with the presence of both hippocampal sclerosis and epileptiform activity in the mesiobasal structures (n = 15); 2) patients with identified sclerosis of the hippocampus, without registration of specific activity according to the results of ECoG (n = 8); 3) patients with epileptiform activity, while MR-negative (n = 10); 4) patients without epileptiform activity and without signs of hippocampal sclerosis according to MRI (n = 3). After a statistical check of the distribution of patients, it was found that the distribution was random. Conclusion. The fact of the presence of structural changes in the hippocampus could not be a pathognomonic sign of the inclusion of the hippocampal-entorial complex in the epileptic system.

Long-term outcome of extratemporal resection in posttraumatic epilepsy

2012 ◽  
Vol 32 (3) ◽  
pp. E10 ◽  
Author(s):  
Shahin Hakimian ◽  
Amir Kershenovich ◽  
John W. Miller ◽  
Jeffrey G. Ojemann ◽  
Adam O. Hebb ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Term Outcome ◽  
Intracranial Eeg ◽  
Long Term Outcome ◽  
Posttraumatic Epilepsy ◽  
Factors Associated

Object Posttraumatic epilepsy (PTE) is a common cause of medically intractable epilepsy. While much of PTE is extratemporal, little is known about factors associated with good outcomes in extratemporal resections in medically intractable PTE. The authors investigated and characterized the long-term outcome and patient factors associated with outcome in this population. Methods A single-institution retrospective query of all epilepsy surgeries at Regional Epilepsy Center at the University of Washington was performed for a 17-year time span with search terms indicative of trauma or brain injury. The query was limited to adult patients who underwent an extratemporal resection (with or without temporal lobectomy), in whom no other cause of epilepsy could be identified, and for whom minimum 1-year follow-up data were available. Surgical outcomes (in terms of seizure reduction) and clinical data were analyzed and compared. Results Twenty-one patients met inclusion and exclusion criteria. In long-term follow-up 6 patients (28%) were seizure-free and an additional 6 (28%) had a good outcome of 2 or fewer seizures per year. Another 5 patients (24%) experienced a reduction in seizures, while only 4 (19%) did not attain significant benefit. The presence of focal encephalomalacia on imaging was associated with good or excellent outcomes in 83%. In 8 patients with the combination of encephalomalacia and invasive intracranial EEG, 5 (62.5%) were found to be seizure free. Normal MRI examinations preoperatively were associated with worse outcomes, particularly when combined with multifocal or poorly localized EEG findings. Two patients suffered complications but none were life threatening or disabling. Conclusions Many patients with extratemporal PTE can achieve good to excellent seizure control with epilepsy surgery. The risks of complications are acceptably low. Patients with focal encephalomalacia on MRI generally do well. Excellent outcomes can be achieved when extratemporal resection is guided by intracranial EEG electrodes defining the extent of resection.

Extent of Resection in Temporal Lobectomy for Epilepsy. II. Memory Changes and Neurologic Complications

Epilepsia ◽  
1989 ◽  
Vol 30 (6) ◽  
pp. 763-771 ◽  
Author(s):  
Amiram Katz ◽  
Issam A. Awad ◽  
Alan K. Kongy ◽  
Gordon J. Chelune ◽  
Richard I. Naugle ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Neurologic Complications

scholarly journals The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy

Brain ◽  
2007 ◽  
Vol 130 (2) ◽  
pp. 548-560 ◽  
Author(s):  
A. B. Vinton ◽  
R. Carne ◽  
R. J. Hicks ◽  
P. M. Desmond ◽  
C. Kilpatrick ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Extent Of Resection ◽  
Temporal Lobectomy

scholarly journals Factors Associated With Failed Focal Neocortical Epilepsy Surgery

Neurosurgery ◽  
2014 ◽  
Vol 75 (6) ◽  
pp. 648-656 ◽  
Author(s):  
Dario J. Englot ◽  
Kunal P. Raygor ◽  
Annette M. Molinaro ◽  
Paul A. Garcia ◽  
Robert C. Knowlton ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Resection Margins ◽  
Epileptic Focus ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Neocortical Epilepsy

Abstract Background: Seizure outcomes after focal neocortical epilepsy (FNE) surgery are less favorable than after temporal lobectomy, and the reasons for surgical failure are incompletely understood. Few groups have performed an in-depth examination of seizure recurrences to identify possible reasons for failure. Objective: To elucidate factors contributing to FNE surgery failures. Methods: We reviewed resections for drug-resistant FNE performed at our institution between 1998 and 2011. We performed a quantitative analysis of seizure outcome predictors and a detailed qualitative review of failed surgical cases. Results: Of 138 resections in 125 FNE patients, 91 (66%) resulted in freedom from disabling seizures (Engel I outcome). Mean ± SEM patient age was 20.0 ± 1.2 years; mean follow-up was 3.8 years (range, 1–17 years); and 57% of patients were male. Less favorable (Engel II–IV) seizure outcome was predicted by higher preoperative seizure frequency (odds ratio = 0.85; 95% confidence interval, 0.78–0.93), a history of generalized tonic-clonic seizures (odds ratio = 0.42; 95% confidence interval, 0.18–0.97), and normal magnetic resonance imaging (odds ratio = 0.30; 95% confidence interval, 0.09–1.02). Among 36 surgical failures examined, 26 (72%) were related to extent of resection, with residual epileptic focus at the resection margins, whereas 10 (28%) involved location of resection, with an additional epileptogenic zone distant from the resection. Of 16 patients who received reoperation after seizure recurrence, 10 (63%) achieved seizure freedom. Conclusion: Insufficient extent of resection is the most common reason for recurrent seizures after FNE surgery, although some patients harbor a remote epileptic focus. Many patients with incomplete seizure control are candidates for reoperation.

Neurocognitive efficiency following left temporal lobectomy: standard versus limited resection

1993 ◽  
Vol 79 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Ronald L. Wolf ◽  
Robert J. Ivnik ◽  
Kathryn A. Hirschorn ◽  
Frank W. Sharbrough ◽  
Gregory D. Cascino ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Cognitive Change ◽  
Cognitive Outcome ◽  
Temporal Lobectomy ◽  
Seizure Onset ◽  
Content Type ◽  
Lateral Cortex ◽  
Intractable Seizures ◽  
Temporal Structures ◽  
Fine Print

✓ Decreased memory and learning efficiency may follow left temporal lobectomy. Debate exists as to whether the acquired deficit is related to the size of the surgical resection. This study addresses this question by comparing changes in cognitive performance to the extent of resection of both mesial temporal structures and lateral cortex. The authors retrospectively reviewed 47 right-handed patients who underwent left temporal lobectomy for medically intractable seizures. To examine the effects of the extent of mesial resection, the patients were divided into two groups: those with resection at the anterior 1 to 2 cm of mesial structures versus those with resection greater than 2 cm. To examine the effects of the extent of lateral cortical resection, patients were again divided into two groups: those with lateral cortex resections of 4 cm or less versus those with resections greater than 4 cm. Statistical analyses showed no difference in cognitive outcome between the groups defined by the extent of mesial resection. Likewise, no difference in cognitive outcome was seen between the groups defined by the extent of lateral cortical resection. Associated data analyses did, however, reveal a negative correlation of cognitive change with patient age at seizure onset. These results showed that the neurocognitive consequences of extended mesial resections were similar to those of limited mesial resections, and that the neurocognitive consequences of extended lateral cortical resections were similar to those of limited lateral cortical resections. The risk of cognitive impairment depends more on age at seizure onset than on the extent of mesial or lateral resection.

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