Abstract
BackgroundAnterior temporal lobectomy (ATL) as a treatment for drug-resistant temporal lobe epilepsy (TLE) frequently causes visual field deficits (VFDs). Reported VFD encompasses homonymous contralateral upper quadrantanopia. Its reported incidence ranges from 15 to 90%. To date, a quantitative method to evaluate postoperative VFD in static perimetry is not available. A method to quantify postoperative VFD, which allows for comparison between groups of patients, was developed.MethodsFifty-five patients with drug-resistant TLE, who underwent ATL with pre- and postoperative perimetry, were included. Temporal lobe resection length was measured on postoperative MRI. Percentage VFD was calculated for the total visual field, contralateral upper quadrant, or other three quadrants combined.ResultsPatients were divided into groups by resection size (< 45 and ≥ 45 mm) and side of surgery (right and left). We found significant higher VFD in the ≥ 45 vs. < 45 mm group (2.3 ± 4.4 vs. 0.7 ± 2.4%,p = 0.04) for right-sided ATL. Comparing VFD in both eyes, we found more VFD in the right vs. left eye following left-sided ATL (14.5 ± 9.8 vs. 12.9 ± 8.3%, p = 0.03). We also demonstrated significantly more VFD in the < 45 mm group for left- vs. right-sided surgery (6.7 ± 6.7 vs. 13.1 ± 7.0%, p = 0.016). A significant quantitative correlation between VFD and resection size for right-sided ATL was shown (r = 0.52, p < 0.01).ConclusionsWe developed a new quantitative scoring method for the assessment of postoperative visual field deficits after temporal lobe epilepsy surgery and assessed its feasibility for clinical use. A significant correlation between VFD and resection size for right-sided ATL was confirmed.
Highlights
Despite the availability of many antiepileptic drugs, an estimated 30–40% of epilepsy patients are drug-resistantActa Neurochir (2018) 160:1325–1336[5, 7]
To compensate for variations in head size and possible metrical distortion introduced by magnetic resonance imaging (MRI), the extent of resection was expressed as a fraction of the distance between the anterior tip of the middle sphenoid fossa to the occipital pole, shown in d centre for epileptology and epilepsy surgery
A Rodenstock perimetry scoring chart was digitally put over a grid in Microsoft Excel (Microsoft, Office, 2013), giving the different assessed points of the perimetry a coordinate which corresponds to that point
Summary
Despite the availability of many antiepileptic drugs, an estimated 30–40% of epilepsy patients are drug-resistantActa Neurochir (2018) 160:1325–1336[5, 7]. Epilepsy surgery is a successful and cost-effective therapy to achieve seizure freedom [6]. Epilepsy surgery for temporal lobe epilepsy has been found effective with reported seizure freedom rates of 70–80% [20]. Temporal lobe surgery encompasses anterior temporal lobectomy (ATL) with or without amygdalohippocampectomy or tailored variants. The most common reported VFD is a contralateral homonymous upper quadrantanopia, clinically often referred to as a pie in the sky [6, 23]. Anterior temporal lobectomy (ATL) as a treatment for drug-resistant temporal lobe epilepsy (TLE) frequently causes visual field deficits (VFDs). Reported VFD encompasses homonymous contralateral upper quadrantanopia. Methods Fifty-five patients with drug-resistant TLE, who underwent ATL with pre- and postoperative perimetry, were included. Percentage VFD was calculated for the total visual field, contralateral upper quadrant, or other three quadrants combined
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