Abstracts

Rationale: Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing a surgical approach remain uncertain.Methods: Eleven consecutive patients with MTLE underwent SEEG evaluation and, based on the findings, were placed in either the medial or medial + lateral group. Medial group patients underwent SAH via subtemporal approach, and medial + lateral patients underwent SEEG based anterior temporal lobectomy.Results: Among the 11 cases, 4 patients were in the medial group, and 7 patients were in the medial + lateral group. The overall seizure outcome at Engel class I and ILAE class 1 was 90.9%, 72.7% respectively. The subcategorized Engel class I seizure outcome in the medial group and in the medial + lateral group was 100%, 85.7%, respectively. SEEG findings were comparable with of FDG-PET results (10 of 11, 91%). Conclusions: Tailored surgery based on SEEG is electrophysiologically feasible treatment for MTLE that can result in favorable seizure outcomes and minimization of neuropsychological decline. Although seizure onset of MTLE is thought to come from the medial temporal structure, in some cases contribution from the lateral temporal cortex should be considered.