Abstracts

RATIONALE: Selective amygdalohippocampectomy is an attractive surgical alternative to standard temporal lobectomy in patients with hippocampal sclerosis, because it spares lateral temporal structures and obviates the need for language mapping. It is not clear if amygdalohippocampectomy is associated with a less favorable surgical outcome.
METHODS: We reviewed seizure outcome in patients with dominant mesial left temporal lobe epilepsy and hippocampal sclerosis by MRI, who had epilepsy surgery at our institution. We included patients who had a tailored left temporal lobectomy after subdural grid implantation and those who underwent selective amygdalohippocampectomy through a transcortical approach. We included only patients with at least one year of follow-up. An image-guided transcortical approach to the temporal horn was performed for all selective amygdalohippocampectomies.
RESULTS: 23 of 29 (79%) of patient with a tailored temporal lobectomy had excellent seizure outcome (Engel class I), compared to 8 of 9 (89%) patients with selective amygdalohippocampectomy. No patient had persistant language disturbance after either selective amygdalohippocampectomy or standard lobectomy 1 year after surgery.
CONCLUSIONS: Transcortical selective amygdalohippocampectomy is a safe and effective alternative to tailored temporal lobectomy in patients with dominant hemisphere mesial temporal epilepsy with hippocampal sclerosis. At least a similar outcome was reached, without invasive language mapping.