Epileptic disorders : international epilepsy journal with videotape · 2025
Mesial temporal lobe epilepsy with hippocampal sclerosis: Seizure, neuropsychological, and quality of life outcomes of 100 patients treated with trans-anterior T1 selective amygdalohippocampectomy.
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Usui Naotaka, Ogawa Hiroshi, Kondo Akihiko, Matsuda Kazumi, Hashiguchi Mitsuru, Okumura Taro, Ishida Yuuki, Kawaguchi Norihiko, Matsudaira Takashi, Tokumoto Kentaro, Nishida Takuji, Imai Katsumi
Аннотация
OBJECTIVE: For mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS), laser interstitial thermal therapy has recently been increasingly used. At our institute, however, selective amygdalohippocampectomy by a trans-anterior T1 subpial approach (trans-anterior T1 SAH) has been used for MTLE with HS. Here, we examined the seizure, neuropsychological, and quality of life (QOL) outcomes after trans-anterior T1 SAH.
METHODS: One hundred patients with MTLE with HS who underwent trans-anterior T1 SAH and were followed for at least 1 year after surgery were included. Seizure outcomes, intelligence and memory, visual field changes evaluated by perimetry, and QOL were investigated.
RESULTS: Seizure-free outcome (Engel class I) at the latest follow-up (mean 4.6 years) was achieved in 88/100 (88%) patients. Only 1 of 100 patients underwent intracranial EEG. Postoperative contralateral upper quadrantanopia was detected in only 15/73 (21%) of patients. Significant improvements in full-scale IQ, verbal IQ, and performance IQ, as examined by the Wechsler Adult Intelligence Scale-III, were seen in both the language-dominant-side surgery and the language-nondominant-side surgery groups. In patients who underwent language-dominant-side SAH, significant declines in general memory and verbal memory scores on the Wechsler memory scale - revised edition were observed at a group level. Significant improvement in attention/concentration was seen regardless of the surgical side. QOL analysis revealed that approximately 30% of patients felt their memory declined after surgery; however, half of the patients felt that being free to go out and become employed was an advantage, and about 90% of patients were satisfied with their surgical treatment.
SIGNIFICANCE: Trans-anterior T1 SAH led to favorable seizure outcomes in about 90% of patients with MTLE with HS. Most patients were pleased with their surgery. In patients with MTLE with HS, the preferred surgical strategy should still be SAH.
METHODS: One hundred patients with MTLE with HS who underwent trans-anterior T1 SAH and were followed for at least 1 year after surgery were included. Seizure outcomes, intelligence and memory, visual field changes evaluated by perimetry, and QOL were investigated.
RESULTS: Seizure-free outcome (Engel class I) at the latest follow-up (mean 4.6 years) was achieved in 88/100 (88%) patients. Only 1 of 100 patients underwent intracranial EEG. Postoperative contralateral upper quadrantanopia was detected in only 15/73 (21%) of patients. Significant improvements in full-scale IQ, verbal IQ, and performance IQ, as examined by the Wechsler Adult Intelligence Scale-III, were seen in both the language-dominant-side surgery and the language-nondominant-side surgery groups. In patients who underwent language-dominant-side SAH, significant declines in general memory and verbal memory scores on the Wechsler memory scale - revised edition were observed at a group level. Significant improvement in attention/concentration was seen regardless of the surgical side. QOL analysis revealed that approximately 30% of patients felt their memory declined after surgery; however, half of the patients felt that being free to go out and become employed was an advantage, and about 90% of patients were satisfied with their surgical treatment.
SIGNIFICANCE: Trans-anterior T1 SAH led to favorable seizure outcomes in about 90% of patients with MTLE with HS. Most patients were pleased with their surgery. In patients with MTLE with HS, the preferred surgical strategy should still be SAH.