Abstracts

Rationale: Temporal lobe epilepsy (TLE) is the most common form of refractory epilepsy. Studies have shown superiority of temporal lobectomy over medical therapy in terms of the control of seizures and the quality of life in TLE. Standard technique of Anterior Temporal Lobectomy can lead to complications such as brain shift, hematoma into the post operative cavity, superior quadrantanopia, cranial nerve palsies and stroke. In addition, this procedure requires a larger craniectomy, is more traumatic and prolongs hospital stay. We report our experience of selective Amygdalo-hippocampectomy (sAH) followed by anterior temporal lobe disconnection in patients with lesional mesial temporal lobe epilepsy. Methods: We retrospectively carried out an observational cohort study at National Neuroscience Institute, King Fahad Medical City. The patients recruited went through a comprehensive presurgical epilepsy evaluation and were concluded as good candidate for temporal lobe resective surgery. Surgeries were done under MRI neuronavigation in Brain Suite™. Small craniotomy 3.5cm x 3.5 cm was made in the temporal area on the diseased side, (figure A). Electrocorticography (ECoG) was done pre-resection from the anterior lateral temporal neocortex. Following that sAH was done via middle temporal gyrus approach. Post sAH, ECoG was done to see any residual epileptiform discharges, if still firing, then the anterior temporal disconnection was carried out. The disconnection was done along the imaginary line drawn from the central point (point of intersection between Central Sulcus to the Sylvian Fissure) to the base of temporal lobe,(figure B& C). Results: We found 6 patients who underwent sAH along with anterior Temporal lobe disconnection between Nov 2008 and May 2012. There were 4 male and 2 females with mean (± SD) age of 27.8 (± 4.8) years and duration of epilepsy as 19.7 (±9.6 ) years, (table). Five procedures were done on the left side. No intraoperative and immediate post operative complications were seen. Histopathology showed mesial temporal sclerosis in 4, focal cortical dysplasia in 1 and pilocytic astrocytoma in 1 patient. Average follow up duration was 14.3 months (range 1- 43 months). All patients have been seizure free post op, with two patients being seizure free for more than 24 months. Conclusions: Selective Amygdalo-hippocampectomy and temporal lobe disconnection under MRI neuronavigation and electrocorticography guidance is safe and effective surgical treatment modality for refractory mesial temporal lobe epilepsy, and may be a possible alternate for standard procedure.