Results of Selective Amygdalohippocampectomy in the Surgical Treatment of Mesial Temporal Sclerosis
Abstract number :
2.204
Submission category :
Year :
2000
Submission ID :
2557
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Eldad J Hadar, William E Bingaman, Imad M Najm, Nancy Foldvary, Cleveland Clin Fdn, Cleveland, OH.
RATIONALE: First described in 1958, the selective amygdalohippocampectomy (SAH) is an alternative to standard temporal lobectomy for the surgical treatment of medically intractable epilepsy in the setting of mesial temporal sclerosis (MTS). The goal of this procedure is anatomic resection of the amygdala and hippocampus with preservation of the temporal neocortex. METHODS:_A retrospective analysis was performed on 23 consecutive patients undergoing SAH at the Cleveland Clinic Foundation from 1997-1999 for MTS. The average patient age was 35.7 years and ranged from 13-57 years. The average duration of epilepsy from first recurrent seizure to surgical resection was 22.5 years and ranged from 5-48 years. The preoperative diagnosis of MTS was made in each patient with a combination of radiographic imaging, video/EEG analysis, semiologic analysis and neuropsychological testing. All but one patient underwent SAH by trans-sulcal approach through the superior temporal sulcus. One patient underwent a trans-sylvian approach. RESULTS:_21 of 23 hippocampal specimens demonstrated characteristic histologic features of hippocampal sclerosis. The remaining two specimens demonstrated extensive gliosis but were not intact enough to be given a diagnosis of hippocampal sclerosis. Follow-up ranged from 1 month to 36 months with an average of 11.2 months. At most recent follow-up, 18 patients (78.2%) were classified as Engel class 1A, one (4.34%) was class 1C, three (13.0%) were class 2B and one (4.34%) was class 4B. Complications included a left superior quadrantanopia in one patient undergoing a right SAH. In those undergoing a left SAH, two had a transient dysphasia (including the patient who underwent a left trans-sylvian SAH) and one has persistent, mild word-finding difficulty at 18 months follow-up. CONCLUSIONS:_Our results demonstrate that SAH is comparable to standard temporal lobectomy with regard to seizure-free outcome. The advantages of SAH include a minimally invasive surgical approach and a potential neuropsychological benefit.