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Sex-related functional asymmetry of the amygdala: Preliminary evidence using a case-matched lesion approach
Published in Howard J. Rosen, Robert W. Levenson, Neurocase, 2020
Daniel Tranel, Antoine Bechara
The amygdala lesion for 3310 is depicted in Figure 2a. There is partial damage to the amygdala on the left. The remaining amygdala tissue likely has little functional connectivity, judging from the adjacent damage to the parahippocampal gyrus. The surgical report for this patient indicated that an amygdalohippocampectomy was performed.
Neurology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Fenella Kirkham, Adnan Manzur, Stephanie Robb
Surgery: Resection for focal lesions (e.g. temporal lobectomy or amygdalohippocampectomy to remove dysplastic and/or scarred tissue, removal of cortical dysembryoplastic neuroectodermal tumour, hemispherectomy).Vagal nerve stimulation.Corpus callosotomy is usually reserved for intractable drop attacks.
Cranial Neurosurgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Mesial temporal epilepsy is commonly medically refractory and can be addressed surgically by amygdalohippocampectomy or resection of the temporal lobe including the mesial structures. The extent of resection is limited by the potential for damage to the optic tracts and to speech areas in the dominant hemisphere. With careful patient selection, cure rates of up to 70% or greater can be achieved.
Withdrawal of antiseizure medications – for whom, when, and how?
Published in Expert Review of Neurotherapeutics, 2023
Francesco Brigo, Serena Broggi, Simona Lattanzi
Resective surgery is an effective option for the treatment of drug-resistant epilepsies, especially for mesial temporal lobe epilepsy [34]. After surgery, 64% to 70% of patients with drug-resistant temporal lobe epilepsy can achieve seizure freedom maintaining ASMs after the procedure, often with a substantially lower dose compared to baseline/pre-surgical status [35]. Data on seizure freedom after ASMs withdrawal in these patients have been accumulated in recent years. The best evidence available so far comes from non-randomized retrospective and prospective studies conducted on relatively homogeneous cohorts of patients undergoing temporal lobe surgery (anterior temporal lobe lobectomy, amygdalohippocampectomy, and lesionectomy) [36]. In clinical practice, ASMs withdrawal in postsurgical patients is not considered before at least one year of seizure freedom after surgical intervention [37,38]. However, in pediatric clinical practice, postoperative ASM withdrawal is usually considered much earlier than 1 year after surgery [39].
Laser thermal ablation in epilepsy
Published in Expert Review of Neurotherapeutics, 2019
Sanjeet S. Grewal, William O. Tatum
Many different types of surgical procedures are available for patients with drug-resistant epilepsy [Table 1] [1,2]. Temporal lobectomy is the most common surgical procedure performed for patients with drug-resistant epilepsy. Despite Class I evidence and practice guidelines by the American Academy of Neurology, utilization of epilepsy surgery has remained static with less than 5% of potential candidates operated [3]. Resection of the anterior temporal lobe is the target in 70% of epilepsy surgeries (amygdala, hippocampus, parahippocampal gyrus) [4]. Seizure-free outcomes result in 60–80% of selected patients but with the risk of cognitive and neurological adverse outcome [5]. Patients who undergo anterior temporal lobectomy may experience category-related object recognition and naming when the white matter of the temporal stem is involved. Collateral damage may decouple the core of language, visual function, and semantic memory. However, overall, quality of life after epilepsy surgery is improved when compared with that of best medical practice [4,5]. Direct costs are lower in 3 years for seizure-free patients and reach cost-effectiveness in 9 years [6]. Selective amygdalohippocampectomy reduces seizure-free outcome by a mean of 8% [7]. Visual field deficits and verbal memory deficits with anterior temporal lobectomy appear greater than selective amygdalohippocampectomy in one study (43.4% v 30.9%) [8]. The potential for effectiveness balances seizure-freedom with the risk of ‘collateral damage’ incurred by larger resection of the anterior temporal lobe [9].
Contemporary surgical management of drug-resistant focal epilepsy
Published in Expert Review of Neurotherapeutics, 2020
Jasmina R. Milovanović, Slobodan M. Janković, Dragan Milovanović, Dejana Ružić Zečević, Marko Folić, Marina Kostić, Goran Ranković, Srđan Stefanović
Frequent problem after dominant temporal lobe resection is impairment of both verbal and visual memory, which is much more pronounced than after non-dominant temporal lobe resection. The patients with dominant temporal lobe resection have 51% lower scores on verbal memory tests and 27% lower scores on visual memory tests after the operation in comparison to preoperative results, while those with non-dominant temporal lobe resections have only 32% loss of verbal memory and negligible loss of visual memory [125]. In patients with mesial temporal lobe epilepsy and hippocampal sclerosis loss of both verbal and visual memory may be mitigated if more selective operation of amygdalohippocampectomy is performed instead of anterior temporal lobe resection [61].