gms | German Medical Science

Objective: Mesial temporal lobe epilepsy (MTLE) is the most common form of epilepsy refractory to medical therapy. Among different surgical approaches available for medically intractable MTLE, selective amygdalohippocampectomy (sAHE) has gained increasing interest for its good rate of sustained seizure control with a simultaneously good to better psychological outcome compared to less selective resections. The aim of this study was to summarize our experience with surgical treatment of MTLE in 191 patients using the transsylvian approach.

Method: Clinical, radiological and histopathological findings of 191 patients with MTLE who were operated at the Epilepsy Centers Bonn and Freiburg by the senior author between 1993 and 2012 were evaluated. Postoperative follow-up ranged from 3 to 120 months (mean: 33 months). Epileptological results were available from 180 cases. In 36 patients with full clinical record, postoperative neuroimaging was correlated to seizure outcome and neuropsychological performance.

Results: Overall, of 180 patients, 137 (76%) remained completely seizure-free, and 161 (89%) had a worthwhile improvement after surgery (≥ 90% reduction of seizure frequency). Operative complications occurred in 21 patients (11%) which where temporary in 19 cases and permanent in two cases. There was no perioperative death. Postoperative gliosis was observed in 25 of 36 cases (69%) without a significant relation neither to seizure outcome nor to neuropsychological performance.

Conclusions: Transsylvian SAH can be recommended as an adequate procedure for the surgical treatment of mesiotemporal epilepsy in the presence of Ammon’s horn sclerosis, tumorous and non-tumorous focal lesions. Postoperative gliosis does not seem to constitute a determinant factor for unfavorable seizure outcome or neuropsychological performance