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Abstracts

Resection of the Atrophic Hippocampal Tail Does Not Improve Seizure Freedom in Anteromesial Temporal Lobe Resection for Temporal Lobe Epilepsy Secondary to Hippocampal Sclerosis

Abstract number : 1.319
Submission category : 9. Surgery / 9A. Adult
Year : 2022
Submission ID : 2204157
Source : www.aesnet.org
Presentation date : 12/3/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:23 AM

Authors :
Debayan Dasgupta, BA, MB BS, MA (Cantab.), MRCS (Eng.) – Queen Square Institute of Neurology, UCL, London, UK; Roisin Finn, FRCS – Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London; Aswin Chari, MA MB BChir MRCS (Eng.) – Department of Neurosurgery, Great Ormond Street Hospital, London, UK; Davide Giampiccolo, MD – Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Jane DeTisi, BA – Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Aidan O'Keeffe, PhD – School of Mathematical Sciences, University of Nottingham, Nottingham, UK; Anna Miserocchi, FRCS (SN) – Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London; Andrew McEvoy, FRCS (SN) – Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London; Sjoerd Vos, PhD – Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom; John Duncan, DM FRCP FRS – Professor, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK

Rationale: Anteromesial temporal lobe resection is the most common surgical technique used to treat drug resistant mesial temporal lobe epilepsy, particularly when secondary to hippocampal sclerosis. Structural and functional imaging data suggest the importance of sparing the posterior hippocampus for minimising language and memory deficits. Recent work has challenged the view that maximal posterior hippocampal resection improves seizure outcome. This study was designed to assess whether resection of posterior hippocampal atrophy was associated with improved seizure outcome._x000D_
Methods: Retrospective analysis of a prospective database of all anteromesial temporal lobe resections performed in individuals with hippocampal sclerosis at our epilepsy surgery centre, 2013-2021. Pre- and post-operative MRI were reviewed by 2 neurosurgical fellows to assess whether the atrophic segment, displayed by automated hippocampal morphometry, was resected, and ILAE seizure outcomes were collected at 1 year. Data analysis used univariate and binary logistic regression._x000D_
Results: Sixty consecutive eligible patients were identified of whom 70% were seizure free (ILAE Class 1 and 2) at one year. There was no statistically significant difference in seizure freedom outcomes (either when ILAE 1 alone was considered, or grouped together with ILAE 2 outcomes) in patients who had complete resection of atrophic posterior hippocampus or not (Fisher’s exact test statistic 0.69 and 1 respectively, not significant at p< .05). The only factor that was associated with seizure outcome in the multivariate analysis was that a history of status epilepticus (p=.04, OR=0.2, 95% CI: 0.042-0.955) was associated with a reduced chance of seizure freedom._x000D_
Surgery