Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy.

Warren Boling

doi:10.3390/brainsci8020035

Abstract

Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a seizure origin in the mesial temporal structures. For those individuals with medically intractable mesial temporal lobe epilepsy, a selective amygdalohippocampectomy surgery can be done that provides an excellent opportunity for seizure freedom and limits the resection to temporal lobe structures primarily involved in seizure genesis.

Highlights

Temporal lobe epilepsy (TLE) affects a substantial number of individuals with medically intractable epilepsy
Due to the strong connections of the mesial temporal structures with the anterior and lateral temporal lobe in addition to other limbic regions, TLE most commonly manifests the semiology of staring and automatisms regardless of the seizure onset zone in lateral or mesial structures of the temporal lobe
Brain Sci. 2018, 8, 35 are defined as lateral or neocortical epilepsy, and seizures that have a focus of onset medial to the collateral sulcus are named mesial temporal lobe epilepsy (MTLE)

Summary

Introduction

Temporal lobe epilepsy (TLE) affects a substantial number of individuals with medically intractable epilepsy. Brain Sci. 2018, 8, 35 are defined as lateral or neocortical epilepsy, and seizures that have a focus of onset medial to the collateral sulcus are named mesial temporal lobe epilepsy (MTLE). The two categories of TLE frequently share the same limbic semiology [11,12,13], in general, MTLE more commonly displays the epigastric, cephalic or experiential aura, loss or awareness, staring, automatisms and posturing that are typical temporal lobe seizure patterns and are the result of a seizure prominently involving the limbic structures [14]. Neocortical epilepsy often spreads along fibers richly connected with the mesial temporal structures manifesting the signs and symptoms of limbic involvement, which are the semiological features of MTLE as well. In a minority of patients, intracranial electrode monitoring may be required to investigate lateralization of the seizure onset to a temporal lobe [23] or to confirm temporal lobar localization in one hemisphere [24]

Temporal Lobectomy

Selective

A Colloquium

Reproduced

Surgical Technique of SAH

Figures and

Key Hole Approach in SAH

Percutaneous Ablation Approaches in SAH

Patient Outcomes from SAH

Findings

Conclusions