Clinical outcomes after medial temporal lobe epilepsy surgery: Anterior temporal lobectomy versus selective amygdalohippocampectomy.

Abstract

To compare the anterior temporal lobectomy (ATL) with transsylvian selective amygdalohippocampectomy (SeAH) in 72 patients with medial temporal lobe epilepsy (MTLE) regarding the seizure control and neuropsychological outcomes. Methods: Clinical data and follow-up data were collected and retrospectively analyzed. SeAH and ATL were used in 39 and 33 patients, respectively. All eligible patients were followed up at least one year. Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised were used to test the patients' neuropsychology before and after the surgery for one year. Results: Fifty-nine patients (81.9%) achieved satisfactory seizure control (62.5% Engel Class I and 19.4% Class II). ATL obtained 84.8% satisfactory seizure control (28 patients), and the success rate was 79.5% (31 patients) for SeAH. There was no significant difference in seizure control between SeAH and ATL (P=0.760). The postoperative verbal IQ of SeAH group increased significantly in both side surgery (P<0.05), while the increase was not significant in the group of ATL of both side surgery (P>0.05). Regarding left-side surgery, postoperative verbal memory and total memory were increased significantly in the group of SeAH (P<0.05), while the increases were not significant in the group of ATL (P>0.05). In the right-side surgery, postoperative verbal memory and total memory were increased significantly in the two surgery strategy groups (P<0.05), while no significant increases were seen in non-verbal memory of the two surgery strategy groups (P>0.05). Conclusion: Microsurgery for the treatment of refractory MTLE is successful and safe, and should be encouraged. The seizure outcome is not different between ATL and SeAH, while regarding as verbal IQ and verbal memory outcomes, SeAH may be superior to ATL in dominant hemisphere surgery.