Neuropsychology outcomes following trephine epilepsy surgery

The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy

Mike R. Schoenberg, William E. Clifton, Ryan W. Sever, Fernando Vale Diaz

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE)that are refractory to medical management. The inferior temporal gyrus (ITG) approachprovides access to the mesial temporal lobe (MTL) structures with minimal tissuedisruption. Reported neuropsychology outcomes following this approach are limited.OBJECTIVE: To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospectivedesign.METHODS: Fifty-four participants had Engel class I/II outcome following resection of MTLusing the ITG approach. All participants had localization-related epilepsy confrmed bylong-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, andneuropsychology assessment.RESULTS: Clinical semiology/video-electroencephalography indicated that of the 54patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) hadpathology-confrmed mesial temporal sclerosis (MTS). Group level analyses found declinesin verbal memory for patients with language-dominant resections (P <.05). No significant decline in neuropsychological measures occurred for patients with MTS. Participantswithout MTS who underwent a language-dominant lobe resection exhibited a signifcantdecline in verbal and visual memory (P <.05). Nondominant resection participants did notexhibit signifcant change in neuropsychology scores (P >.05).CONCLUSION: Neuropsychology outcomes of an ITG approach for selective mesialtemporal resection are comparable to other selective AH techniques showing minimaladverse cognitive effects. These data lend support to the ITG approach for selective AHas an option for MTLE.

Original languageEnglish (US)
Pages (from-to)833-841
Number of pages9
JournalNeurosurgery
Volume82
Issue number6
DOIs
StatePublished - Jan 1 2018

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Neuropsychology
Temporal Lobe Epilepsy
Temporal Lobe
Epilepsy
Electroencephalography
Magnetic Resonance Imaging
Partial Epilepsy
Sclerosis
Language

Keywords

  • Amygdalohippocampectomy
  • Epilepsy
  • Inferior temporal gyrus
  • Neuropsychological outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Neuropsychology outcomes following trephine epilepsy surgery : The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy. / Schoenberg, Mike R.; Clifton, William E.; Sever, Ryan W.; Vale Diaz, Fernando.

In: Neurosurgery, Vol. 82, No. 6, 01.01.2018, p. 833-841.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE)that are refractory to medical management. The inferior temporal gyrus (ITG) approachprovides access to the mesial temporal lobe (MTL) structures with minimal tissuedisruption. Reported neuropsychology outcomes following this approach are limited.OBJECTIVE: To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospectivedesign.METHODS: Fifty-four participants had Engel class I/II outcome following resection of MTLusing the ITG approach. All participants had localization-related epilepsy confrmed bylong-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, andneuropsychology assessment.RESULTS: Clinical semiology/video-electroencephalography indicated that of the 54patients, 28 (52{\%}) had left MTLE and 26 (48{\%}) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43{\%}), nondominant on 31(57{\%}). Twenty-nine (29) hadpathology-confrmed mesial temporal sclerosis (MTS). Group level analyses found declinesin verbal memory for patients with language-dominant resections (P <.05). No significant decline in neuropsychological measures occurred for patients with MTS. Participantswithout MTS who underwent a language-dominant lobe resection exhibited a signifcantdecline in verbal and visual memory (P <.05). Nondominant resection participants did notexhibit signifcant change in neuropsychology scores (P >.05).CONCLUSION: Neuropsychology outcomes of an ITG approach for selective mesialtemporal resection are comparable to other selective AH techniques showing minimaladverse cognitive effects. These data lend support to the ITG approach for selective AHas an option for MTLE.",
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