Temporopolar amygdalohippocampectomy: seizure control and postoperative outcomes

Autor: Fernando Cendes, Andrei Fernandes Joaquim, Gabriel Marquez, Brunno Machado de Campos, Tátila Martins Lopes, Gabriel Ayub, Letícia F. Ribeiro, Enrico Ghizoni, Tamires Araujo Zanao, Fabio Rogerio, Clarissa L. Yasuda, Vinicius Domene, Luciana Ramalho Pimentel-Silva, Helder Tedeschi, José Paulo Cabral de Vasconcellos, Mateus Henrique Nogueira, João Paulo Sant Ana Santos de Souza
Přispěvatelé: UNIVERSIDADE ESTADUAL DE CAMPINAS
Rok vydání: 2021
Předmět:
Male
Drug Resistant Epilepsy
Neuropsychological Tests
Audiology
Hippocampus
Neurosurgical Procedures
Cohort Studies
Postoperative Complications
0302 clinical medicine
Artigo original
Medicine
Child
Intelligence quotient
Amygdalohippocampectomy
General Medicine
Amygdala
White Matter
Temporal Lobe
Diffusion Tensor Imaging
Treatment Outcome
Boston Naming Test
030220 oncology & carcinogenesis
Female
Anatomic Landmarks
Tractography
Adult
medicine.medical_specialty
Adolescent
Temporal lobe
Young Adult
03 medical and health sciences
Visual memory
Seizures
Epilepsia do lobo temporal
Humans
Speech
Epilepsy
Temporal lobe
Hippocampal sclerosis
business.industry
Anterior Temporal Lobectomy
medicine.disease
Epilepsy
Temporal Lobe
Temporal stem
Visual Fields
Verbal memory
business
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: Repositório da Produção Científica e Intelectual da Unicamp
Universidade Estadual de Campinas (UNICAMP)
instacron:UNICAMP
ISSN: 1933-0693
0022-3085
DOI: 10.3171/2020.3.jns192624
Popis: OBJECTIVE The objective of this study was to evaluate the efficacy and safety of a modified surgical approach for the treatment of temporal lobe epilepsy secondary to hippocampal sclerosis (HS). This modified approach, called temporopolar amygdalohippocampectomy (TP-AH), includes a transsylvian resection of the temporal pole and subsequent amygdalohippocampectomy utilizing the limen insula as an anatomical landmark. METHODS A total of 61 patients who were diagnosed with HS and underwent TP-AH between 2013 and 2017 were enrolled. Patients performed pre- and postoperative diffusion tensor imaging and were classified according to Engel’s scale for seizure control. To evaluate the functional preservation of the temporal stem white-matter fiber tracts, the authors analyzed postoperative Humphrey perimetries and pre- and postoperative neurocognitive performance (Rey Auditory Verbal Learning Test [RAVLT], Weschler Memory Scale–Revised [WMS-R], intelligence quotient [IQ], Boston Naming Test [BNT], and semantic and phonemic fluency). Demographic data and surgical complications were also recorded and described. RESULTS After a median follow-up of 36 ± 16 months, 46 patients (75.4%) achieved Engel class I, of whom 37 (60.6%) were Engel class IA. No significant changes in either the inferior frontooccipital fasciculus and optic radiation tractography were observed postoperatively for both left- and right-side surgeries. Reliable perimetry was obtained in 40 patients (65.6%), of whom 27 (67.5%) did not present any visual field defects (VFDs) attributable to surgery, while 12 patients (30%) presented with quadrant VFD, and 1 patient (2.5%) presented with hemifield VFD. Despite a significant decline in verbal memory (p = 0.007 for WMS-R, p = 0.02 for RAVLT recognition), there were significant improvements in both IQ (p < 0.001) and visual memory (p = 0.007). Semantic and phonemic fluency, and scores on the BNT, did not change postoperatively. CONCLUSIONS TP-AH provided seizure control similar to historical temporal lobe approaches, with a tendency to preserve the temporal stem and a satisfactory incidence of VFD. Despite a significant decline in verbal memory, there were significant improvements in both IQ and visual memory, along with preservation of executive function. This approach can be considered a natural evolution of the selective transsylvian approach.
Databáze: OpenAIRE
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